Paraneoplastic effects on neurophthalmologic function

Paraneoplastic neurologic syndrome with otoneurophthalmologic manifestations is much less common than direct, metastatic, and treatment-related complications of cancer. Few studies have focused on patients presenting with paraneoplastic syndrome before a cancer is identified. We describe a case of combined paraneoplastic brainstem/limbic encephalitis and Lambert-Eaton myasthenic syndrome in a patient with small cell lung cancer and positive antiamphiphysin antibodies who initially presented with otoneurophthalmologic signs and symptoms to the ears, nose, and throat clinic. To the best of the authors' knowledge, this combined form of disease, confirmed by both clinical and laboratory tests, is one of the rarest cases ever to be reported. Immunoglobulin G polyclonal antibodies directed against amphiphysin have been detected in a few stiff-person syndrome patients, especially those with breast cancer. This case is again unusual in the sense that the patient was positive for antiamphiphysin antibodies, but negative for anti-Hu antibodies. Patients initially presenting with otoneurophthalmologic signs and symptoms with no detectable lesions in the central nervous system should be promptly and thoroughly investigated and monitored carefully for a possible malignancy elsewhere in their bodies without waiting for the actual malignancy to manifest itself at a later stage, thus increasing the prospect of detecting the malignancy and optimizing the treatment modalities at an earlier stage.