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Two patients successfully treated for prostatic cancer developed a progressive neurologic syndrome beginning with loss of voluntary horizontal eye movements followed by severe,persistent muscle spasms of the face,jaw and pharynx.Both had mild gait unsteadiness and one exhibited facial and abdominal myoclonus.Extensive diagnostic studies including MRI of the brainstem(with and without contrast)were normal.CSF examination showed mild pleocytosis and elevated IgG.Quantitative eye movement recordings documented selective involvement of voluntary horizontal saccades with sparing of horizontal slow eye movements.Neither patient had antineuronal antibodies in the blood.Postmortem examination revealed perivascular chronic inflammatory cells and microglial infiltration of the pons and medulla.One patient also had perivascular infiltrates in both mesial temporal lobes.Neuronal loss was localized to the pontine tegmentum,the medullary sensory nuclei,and the cerebellum.Brainstem motor nuclei were preserved.The clinical and pathologic findings suggest an autoimmune process(probably paraneoplastic)with selective damage to a subpopulation of brainstem neurons critical for horizontal eye movements and recurrent inhibition of bulbar nuclei. |
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brainstem,lesion of
carcinoma of prostate
encephalitis,brainstem
eye movement,disorders of
gaze palsy,horizontal
muscle spasm,face
myoclonus
myoclonus,face
paramedian pontine reticular formation
remote effect of cancer on the nervous system
saccadic eye movements
saccadic eye movements,abnormal
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