A unique case of pronounced neurologic deficit from paraneoplastic syndrome that precedes appearance of mediastinal germinoma by two years

Abstract

Paraneoplastic neurologic disorder may be the initial manifestation of a tumor, with the diagnosis of malignancy commonlyfound within six months of the onset of neurologic symptoms. This diagnosis is usually made on clinical grounds, as antineuronalantibodies are infrequently positive, though anti-Hu antibodies have been associated commonly with lung cancer. Typically,neurologic manifestations of germinomas include limbic and brainstem encephalitis in association with anti-Ma2 antibodies.To our knowledge, germinomas have not been associated with paraneoplastic cerebellar degeneration with anti-Hu antibodypositivity. Here we report a case where neurologic deficits and anti-Hu positivity indicative of a paraneoplastic syndrome precedesthe development of a mediastinal germinoma by two years.