Ataxia and Gait Disorders

Question 1

Symptoms of Cerebellar Disease

Answer 1

Dysmetria, Intention tremor, Dysdiadokinesis, Gait Ataxia, Truncal ataxia, Dysarthria, Nystagmus

Question 2

Cerebellar Hemorrhage or Infarction

Answer 2

abrupt onset of vertigo, vomiting, and inability to walk

Question 3

Alcoholic Cerebellar Degeneration

Answer 3

+Alcoholic polyneuropathy

Mostly vermis meaning progressive gait and truncal ataxia

Question 4

Post infectious cerebellitis

Answer 4

Age 2-7yo, self limited. rule out mass, drug intoxication

Question 5

Paraneoplastic Cerebellar Degeneration

Answer 5

ACute or subacute onset of pancerebellar syndrome w truncal, gait, and limb ataxia, dysarthria, ocular motility
Anti yo, anti hu

Question 6

Friedrich ataxia

Answer 6

Autosomal recessive
Progressive ataxia, Arms> legs. Onset is childhood. loss of reflexes, spasticity, extensor plantar reponses, impaired vibration

Question 7

Inherited Episodic Ataxia

Answer 7

Brief periods, K channels

Question 8

Miller Fisher

Answer 8

TRIAD:
Ataxia, areflexia, ophthalmoplegia
Proprioceptive loss, post-infectious like GBS, IgG anti GQib

Question 9

40 yo. Gradual unilateral hearing loss, high pitched ringing in ear.

Answer 9

Acoustic schwannoma, cerebellopontine angle meningioma

Question 10

In bed severe spinning ,dizziness, nausea

Answer 10

Benign paroxysmal positional vertigo. Epply maneuver to cure. Dix Hallpike maneuver is provocative maneuver.
Unidirectional nystagmus.
mixed vertical-torsional nystagmus with fast phase beating upward (posterior canal) or downward (anterior canal) and toward the affected ear. If left torsion, left ear.

Question 11

25 yo. Multiple, periodic episodes of vertigo, tinnitus, and eventually low frequency hearing loss

Answer 11

Menieres disease.

rx: labyrinthine ablation with gentamicin.

Question 12

45 year old. 10 days of dizziness, dysarthria, ataxia. Bilateral dysmetria of upper and lower extremities

Answer 12

Paraneoplastic syndrome
Anti-Yo.
small cell lung, gynecologic, Non-Hodgkin’s lymphoma.

Question 13

72 yo with severe occipital headaches several hours ago. Spinning and falls to the right. Worsened by coughing and +vomiting. Bilateral horizontal nystagmus. High BP.

Answer 13

Cerebellar hemorrhage

Question 14

55yo man. Unsteadiness, lightheadedness on standing. Mild resting tremor and cogwheeling in upper limbs. Orthostatic hypotension. Profound constipation.

Answer 14

Multiple system atrophy (Shy-Drager)

parkinsonisms plus syndrome (autonomic insufficiency)

Question 15

ataxia, urinary incontinence. Recovered from pneymococcal meningitis 5 years ago

Answer 15

Communicating hydrocephalus NPH

Question 16

Albuminocytologic dissociation

Answer 16

GBS