1. CEREBELLAR DISEASES QUIZ Dr. S. Aswini Kumar. MD. 1. A 75 year-old man is admitted with acute onset of ataxia with tendency to fall to the left. No headache or vomiting. O/E there are cerebellar signs on the left side. No cranial nerve affected. No other long tract signs. Patient is conscious. Gradual recovery occurs over a period of two weeks 2. A 65 year old man presented with history of acute onset of occipital headache and vomiting. On examination, the patient was stuporus. Ipsilateral cerebellar signs were present, along with conjugate deviation to opposite side. Gradual worsening occurred and he died after 6 hours3. A 45 year old female presented with acute onset of occipital headache and vomiting. There was history of CSOM in the past. O/E she was febrile. Papilledema was present bilaterally (left > right). Cerebellar signs were elicited on left side. No other long tract signs were present . Plantars flexor.4. A 55 year old man presented with acute onset of vertigo and vomiting, followed by hiccups and numbness of right side of face. Numbness was also present on the left half of the body. Cerebellar signs were present on the right side along with palatal weakness on the same side. No long tract signs. 5. A 35 year old lady is admitted with history of acute onset of ataxia and tremor. She was a known epileptic on treatment with dilantin sodium since several years. No headache or vomiting. No cranial nerve palsies or long tract signs. The cerebellar signs were found to be bilateral and progressive6. A 65 year-old man presented with vague symptoms of unsteadiness and giddiness. O/E there is horizontal nystagmus to the left. Corneal reflex is absent on the left side. Lateral rectus weakness, mild LMN facial weakness and perceptive deafness on the left side. Cerebellar signs are evident on left.7. There is, in this 25 year old man pes cavus, deformed high arched palate, kyphoscoliosis and ataxia. His head shakes and has intention tremor. There is nystagmus and dysarthria. Position and vibration sense are diminished in the feet. Knee and ankle jerks are absent & plantar responses are extensor8. This 35 year-old female has ataxic nystagmus, temporal pallor of the optic disc & bilateral inter-nuclear ophthalmoplegia. She has slurred speech and ataxia of limbs and wide spread cerebellar signs. There are pyramidal signs and dorsal column signs as well. Surprisingly she is euphoric in spite of severe disability 9. This 65 year-old man, came with imbalance in the gait of 6 months duration. He was having a wide based gait. His hand were trembling and shaking. Nystagmus and dysarthria were present but not prominent. Heel –knee-shin test was positive but Romberg’s sign was negative . 10. A 65 year-old man comes with ataxia and dysarthria of 3 months duration. He has not touched alcohol in his life. O/E there is pallor, clubbing and cachexia. Cerebellar signs are bilateral and extensive. No long tract signs. No rombergism. No signs of meningeal irritation.11. This 55 year old woman was admitted for severe imbalance in gait and headache and projectile vomiting of 3 months duration. O/E there was bilateral papilledema and right sided cerebellar signs which increased steadily over a period. This was followed by gradual loss of consciousness12. This 45 year-old patient presented with a protracted course of progressive ataxia, hemi paresis, aphasia, visual field defects and multiple sensory deficits. Patient gave history of pre marital exposure to promiscuous women. Examination showed evidence of emaciation but normal mentation.13. This 45 year old man presented with progressive cerebellar ataxia of the trunk and limbs, slowness of voluntary movements, scanning speech, nystagmus and oscillatory tremor of head and neck. Ophthalmoparesis and facial weakness along with features of Parkinson's disease14. This 25 year old man started having this illness at the age of 5 as truncal ataxia, extremity ataxia, dysarthria, myoclonic jerks, areflexia, extensor plantar reflex and distal sensory deficits. H/o recurrent pulmonary infections, hepato-splenomegaly and telengectasia were present15. This 15 year old boy presented with severe progressive ataxia and on examination he had optic atrophy, pupillary abnormalities, pigmentary retinal degeneration, sensori-neural deafness, peripheral neuropathy cardiomyopathy and icthyosis 16. This 13 year old boy presented with severe head ache abruptly occurring,especially on bending forward, coughing and lifting weight. O/E had evidence of B/L cerebellar signs along with B/L pyramidal signs. He also had suspended type of dissociated sensory loss in a cape like distribution17This 45 year-old woman presented with history or progressive lethargy, weight gain and cold intolerance of six months duration along with progressive ataxia. On physical examination this obese lady had rough voice and diffuse bilateral cerebellar signs and sluggish angle jerks