Abstract
A 69-year-old gentleman presented with complains of giddiness, gait ataxia, vomiting, and slurring of speech with clinical signs pointing to cerebellar etiology. The magnetic resonance imaging brain revealed no significant abnormality. (18)F-fluorodeoxyglucose ((18)F FDG) positron emission tomography (PET)/computed tomography showed hyper-metabolism in bilateral cerebellar hemispheres, pons, mid-brain and bilateral medial temporal cortices. Further quantitative NeuroQ analysis of (18)F FDG-PET showed similar findings. Paraneoplastic antibody panel (anti-Hu, anti-Yo, anti-Ri, NMDA, CASPR-2 etc.) was negative. Clinical suspicion and PET imaging correlation led the neurologist to suspicion of inflammatory/autoimmune etiology, and the patient was empirically started on four cycles of plasma exchange therapy and course of steroids, however, no significant clinical response was noted. At post-6 months of (18)F FDG-PET, he expired out of respiratory illness (pneumonia).