Cerebellar degeneration with Hodgkin's disease.

A male glassworker, aged 19, who had previously been in good health developed severe occipital headache, made worse by movements of the head and by stooping. A fortnight later the headache had become bitemporal and gradually less severe so that he was able to return to work. During this initial period no abnormal signs appeared in the nervous system or elsewhere although the blood pressure was somewhat labile and was variously recorded as 150/90, 135/75, and 140/100 mm. Hg. Two months later he was referred again because of brief dizzy spells for some of which he had to be taken home from work. During these he would have to hold on to objects to avoid falling and there would at times be nausea and vomiting. A week later he improved sufficiently to attempt to drive a car to visit relatives but on the way he developed double vision and was forced to return. Some days later he drove a hundred miles without trouble. Whilst on holiday, however, double vision recurred, his gait became unsteady, and his speech indistinct. Neurological examination 10 weeks from the onset revealed a pure cerebellar disorder with staccato speech, and a horizontal nystagmus to the left and right. There was such marked ataxia of the limbs and trunk that he was unable to stand unsupported. There was no weakness or sensory loss and the deep and superficial reflexes were normal with flexor plantar responses. The optic fundi were normal and the visual fields full. The remainder of the cranial nerves and the rest of the nervous system showed no abnormality apart from the cerebellar signs. He was admitted to hospital for detailed investigation. The peripheral blood showed a haemoglobin level of 116% (16-9 g.) white blood cells 8,400 per c.mm. (neutrophils 80 %, lymphocytes 18 %, monocytes 2 %). The E.S.R. was 14 mm. in one hour. Urine examination was normal. The total serum protein concentration was 6-5 g.% (albumin 3 5, globulin 2-7, fibrinogen 0-3).