Abstract
Background A 37-year-old Brazilian man was admitted to Massachusetts General Hospital for evaluation of left-sided facial numbness, left-sided ataxia, dizziness, and vertigo. Seven weeks prior to admission, he reported numbness of the left oral cavity and tongue after a dental procedure. Three weeks prior to presentation, he developed left-sided incoordination with dizziness and vertigo. One week later, he noticed difficulty using a box cutter at work and presented to the emergency department for evaluation. A CT scan without contrast revealed no abnormalities and he was discharged home. Three days prior to admission, the patient developed diplopia. Cranial MRI revealed a 1.6 cm irregular enhancing mass in the left middle cerebellar peduncle. Neurologic examination was significant for diminished sensation over the left face to pinprick, left-sided dysmetria, and mild lateral instability of the trunk while walking.
Investigations MRI, lumbar puncture, CT scans of the abdomen and pelvis, needle biopsy of the lymph node, and paraneoplastic antibodies.
Diagnosis Possible paraneoplastic demyelination.
Management Orchiectomy, adjuvant radiation, and corticosteroids.
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Acknowledgements
We would like to thank Drs Tracy Batchelor and John Henson for their assistance with this case report. Dr Scott Plotkin is the Richard B Simches Scholar in Neuro-Oncology at the Massachusetts General Hospital.
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Plotkin, S., Dorfman, M. & Loeffler, J. Facial numbness in a man with inguinal and retroperitoneal masses. Nat Rev Clin Oncol 2, 54–58 (2005). https://doi.org/10.1038/ncponc0059
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DOI: https://doi.org/10.1038/ncponc0059
