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Ballistic-Choreic Movements as the Presenting Feature of Renal Cancer
Kathy A. Kujawa, MD, PhD;
Vanda R. Niemi, MD;
Marie A. Tomasi, MD;
Norman W. Mayer, MD;
Elizabeth Cochran, MD;
Christopher G. Goetz, MD
Arch Neurol. 2001;58:1133-1135.
Background The paraneoplastic syndromes can involve multiple areas of the central
nervous system and result in a variety of neurological symptoms. To our knowledge,
severe, rapidly progressive, and drug-resistant ballistic-choreic movements
have not been previously described as the presenting feature of renal cell
carcinoma.
Patient and Methods A previously healthy 55-year-old man developed limb ballismus and involuntary
choreic movements of his face over several weeks. Extensive laboratory, diagnostic,
and radiographic studies failed to reveal a cause, until an abnormality on
a chest x-ray film prompted a search for a primary neoplasm and a final diagnosis
of renal cell carcinoma. High doses of medications traditionally used to treat
choreic disorders had no effect on the abnormal movements. A biopsy specimen
of the basal ganglia showed focal encephalitic changes but no malignant neoplasm.
Conclusions Whereas prior cases of paraneoplastic syndromes with chorea have been
reported in other forms of cancer, our case was significant because, to our
knowledge, renal cell carcinoma has not been previously reported in association
with this syndrome. Furthermore, the chorea was categorically resistant to
pharmacological treatment, and the movement disorder was the initial and only
focal neurological feature of the primary illness.
From the Departments of Neurological Sciences (Drs Kujawa, Niemi, Tomasi,
Cochran, and Goetz) and Pathology (Dr Cochran) and Rush Medical College (Dr
Mayer), Rush-Presbyterian-St Luke's Medical Center, Chicago, Ill. Dr Kujawa
is now with the Department of Neurology, Glenbrook Hospital, Glenview, Ill;
Dr Niemi is now with Noran Neurological Clinic, Minneapolis, Minn; and Dr
Mayer is now with the Department of Neurological Surgery, University of Louisville,
Louisville, Ky.
Corresponding author and reprints: Kathy A. Kujawa, MD, PhD, Department
of Neurology, Glenbrook Hospital, 2100 Pfingsten Rd, Glenview, IL 60025 (e-mail: k-kujawa{at}northwestern.edu).
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ABSTRACT
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