LAUSR

A-53-year-old woman presented with a 2-week history of dysarthria and gait instability. On admission (day 1), a neurological examination revealed gaze-evoked nystagmus, mild dysarthria and severe truncal ataxia. Slight diffusionweighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) hyperintensity in the right cerebellar cortex were suspected on MRI (Picture). The cerebrospinal fluid (CSF) cell count was 20/μL, the protein level was 47 mg/ dL, and the cytology was negative. Anti-Yo antibodypositive paraneoplastic cerebellar degeneration (PCD) with presumed ovarian cancer was diagnosed after a thorough systemic work-up. Cerebellar symptoms progressed despite steroid pulse therapy, and MRI signal change moved to the bilateral upper portions of the cerebellum on day 21. The apparent diffusion coefficient (ADC) of the lesion was decreased in this second MRI (Picture). Although CSF findings normalized by day 29, the cerebellar symptoms progressed until paraaortic lymphadenectomy and plasma ex-