Abstract

A 47-year previously fit and well lady presented with 6 weeks history of generalised lethargy, weight loss and neck pain. Her examination revealed left supra-clavicular lymph nodes. Subsequent investigations revealed left grade 2 invasive ductal carcinoma of her left breast. This was treated with local excision.

She presented to hospital four weeks following her surgery with progressive double vision and unsteadiness. Her cranial nerve examination showed severly restricted pursuit and saccadic horizontal eye movements with intact vertical eye movements. She had normal strength with intact deep tendon reflexes with plantar flexor response. Her MRI head and spine with contrast and CSF examination, including cytology was normal.

Two weeks into her admission she progressively developed generalised stiffness and severe axial and peripheral rigidity which was made worse with touch or emotions. These symptoms responded to benzodiazepines and baclofen. Her anti-amphiphysin antibodies were positive confirming the diagnosis of stiff person syndrome.

Her breast cancer was treated aggressively with chemotherapy. Her stiffness and rigidity improved briefly following her chemotherapy. Eye movement's problems were described in anti-GAD related stiff person syndrome, which is due to GABA depletion. This is first ever-reported case where eye movement problem (Stiff eyes) is the initial presentation of a anti-amphiphysin antibody related stiff person syndrome.