A 22 years old male patient, labourer by occupation was admitted in our medical ward with a 5 year history of progressive neurological symptom manifesting as ataxia, dysarthria and vertigo.Patient was apparently normal 5 years back when he developed difficulty in walking such that he would sway from side to side and after 1 month he developed a slurring of speech.
For the last 3 months patient was having mild vertigo .There was no history of any altered sensorium, motor weakness,or sensory loss.No history suggestive of cranial nerve involvement.
There was no history of seizures,fever,vomiting,headache,head injury,jaundice,and ear discharge.There was no history of any prior medical illness .The physical examination revealed normal vital signs and laboratory findings. The patient was alert,friendly, and cooperative. His neck was short, there were no deformities of his facial features.The neurological examination revealed that the patient was oriented to time, place, and person. Cranial nerves were normal. Speech appeared to be scanning in nature (video).
The patient also had horizontal nystagmus on both vertical and lateral gaze.There was bilateral finger-to-nose ataxia. The motor strength and reflexes were normal. Sensory examination was unremarkable and his plantar responses were downgoing. An extensive neuropsychological evaluation revealed borderline intelligence, normal memory. In terms of everyday living activities, the patient was able to perform adequately with minor supervision. His heart, chest, and abdomen were unremarkable. The patient had an uneventful birth,neonatal period, and childhood. He stated that he was a slow learner in school and had to be placed in a special class, but he did complete the twelfth grade.
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(c) 2011 M.H. Rivner
November 28, 2011