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Nitkunan et al report a 52-year-old man presenting with an insidious onset of Parinaud's syndrome, hypersomnolence and hyperphagia over 18 months. MR scanning showed high signal change around his dorsal midbrain, medial temporal lobes, amygdala and inferior caudate nuclei and CSF showed a mild lymphocytosis and high protein. All immunological tests were negative, other than high titres of antithyroid peroxidase antibodies. Specifically, a broad screen for antineuronal antibodies and antibodies against membrane channel proteins was negative. FDG-PET scanning identified a small squamous cell carcinoma of the tonsil, which was excised; following this, his relatively mild cognitive symptoms improved ‘partially’ but his general neurological condition remained unchanged, particularly the fatigue and visual disturbance.
The literature is awash with …
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