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Abnormal eye movements occur in a range of paraneoplastic syndromes affecting brainstem and cerebellum, including opsoclonus, slow or dysmetric saccades, impaired smooth pursuit, and gaze-evoked and downbeat nystagmus.1,–,3 We report upbeat nystagmus (UBN) and cognitive impairment as paraneoplastic phenomena in a patient with pancreatic cancer.
Case report.
A 65-year-old woman developed “dizziness” and an “inability to sense myself in space” during a transcontinental flight. She had difficulty walking off the plane, reporting “there is a sensation of backwards motion, with someone trying to push me off my heels.” She also reported impairment of short-term memory for 2 months and a 20-pound weight loss. Vestibular neuritis was diagnosed and prednisone prescribed, but her symptoms progressed. She was admitted to Massachusetts General Hospital. She had smoked 1–2 packs per day for years, but quit 4 years previously.
On examination the patient was alert and appropriately interactive, but depressed and cognitively impaired. She registered 3 items, but could recall none at 5 minutes. She was unable to name the month or her current location. She followed simple and complex commands and could spell “world” backwards. The cranial nerves were normal, apart from abnormal eye movements. During attempted fixation of a far target, she had prominent UBN, lid nystagmus, and saccadic intrusions (video on the Neurology® Web site at www.neurology.org). UBN suppressed during near viewing and showed marked dependency on head position, upbeat when erect, absent when supine, reduced when prone, and beating away from the ground (apogeotropic) when lying …
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