Case presentation

A 63-year-old woman presented as a thrombolysis call with dysarthria, diplopia, vertigo and generalised weakness. She had a history of high-grade serous ovarian cancer, treated 3 years previously with surgery and chemotherapy and believed to be in remission. She also had osteoarthritis of the hips. On examination, there was mild dysarthria, abnormal eye movements in horizontal and vertical planes and generalised limb weakness. MR scan of brain without contrast was normal. The initial diagnosis on the stroke unit was of benign paroxysmal positional vertigo with lower limb weakness exacerbated by hip pain, and probable functional overlay. An Epley manoeuvre gave only minimal clinical benefit. The neurology team assessed her and noted several weeks of progressively slurred speech, oscillopsia, reduced upper limb coordination and unsteady gait. On examination, she had cerebellar dysarthria with frank …