Elsevier

Ophthalmology

Volume 119, Issue 4, April 2012, Pages 865-868
Ophthalmology

Original article
Blepharospasm and Apraxia of Eyelid Opening Associated with Anti-Hu Paraneoplastic Antibodies: A Case Report

https://doi.org/10.1016/j.ophtha.2011.10.008Get rights and content

Purpose

To report a case of blepharospasm associated with anti-Hu paraneoplastic antibodies that was treated successfully with botulinum toxin A.

Design

Case report.

Participants

A 57-year-old man had altered mental status and a 20-pound weight loss at presentation. Evaluation revealed an occult small-cell lung cancer. Despite initiating appropriate chemotherapy, his mental status worsened and over the course of several weeks, he was unable to open his eyes because of forceful orbicularis contractions. Neuroimaging and cerebrospinal fluid studies found no evidence of intracranial metastases. However, his paraneoplastic panel was positive for anti-Hu antibodies. He was diagnosed with paraneoplastic encephalitis and blepharospasm.

Intervention

Intravenous Solu-Medrol (Pharmacia & Upjohn Co, Bridgewater, NJ) and periocular injections of botulinum toxin A.

Main Outcome Measures

Ocular disease control.

Results

Intravenous Solu-Medrol improved his mental status, but did not change his ocular symptoms. Subsequent botulinum toxin A injections allowed spontaneous eyelid opening.

Conclusions

Although paraneoplastic blepharospasm is rare, it is an important diagnosis to be aware of because paraneoplastic disorders often herald an occult tumor. This is the only case of paraneoplastic blepharospasm that the authors know of that was the result of anti-Hu antibodies as well as the only case that was treated with botulinum toxin A.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Patients and Methods

The clinical record of the patient, including clinical notes, laboratory testing, and imaging studies, were reviewed. The patient's response to clinical interventions was recorded. In addition, the available literature was searched for additional cases of paraneoplastic blepharospasm by searching PubMed for paraneoplastic blepharospasm, paraneoplastic dystonia, paraneoplastic blepharoclonus, paraneoplastic apraxia, and paraneoplastic movement disorder. Six cases were discovered and reviewed.

Discussion

Paraneoplastic disorders are becoming widely recognized as a cause of nonmetastatic neurologic symptoms in oncology patients and can cause diffuse sensory, cognitive, motor, and autonomic dysfunction. This diagnosis should be considered only after other metabolic, nutritional, infectious, toxic, and metastatic causes have been ruled out. Classic paraneoplastic syndromes include cerebellar degeneration, encephalomyelitis, limbic encephalitis, Lambert Eaton myasthenic syndrome,

Acknowledgments

The authors thank Dr. Josep Dalmau for reviewing the manuscript and contributing his extensive insight and knowledge on this topic.

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    Manuscript no. 2011-860.

    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    This research was supported in part by a grant from Research to Prevent Blindness.

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