Case of the day

Recurrent Ataxia with Slurring of speech.

Recurrent Ataxia with slurring of speech under Ix.. Can it be MS Or any other cerebellar cause??.. Why there is slurring of speech while cranial Nv examination is normal.. Chief Complaints A 50 yr old male has come with unable to walk properly and slurring of speech since 4-5 months. Pt had similar history back a couple of times, for which he was taking treatment from outside. He was diagnosed as SACD and was taking Hydroxycobalamine without any improvement. I did complete neurological examination. Mental function, cranium, spine, Meninges, motor system, sensory function and cranial nv are normal. Pt had ataxia, with dysdidochokinesia and difficulty with past pointing, incordination, ataxia etc. No nystgmus, titubation or INO. No H/O HTN, T2DM, Thyroid disorder, substance abuse, Trauma, high risk behaviour etc. His previous report shows both cerebellar and cerebral atrophy, normal Sr Vit B12 level, normal Thyroid profile. Now we are planning MRI Brain, MRI spine, Spinal fluid for oligoclonal band etc. Ur opinion plz.. What else need to be done.. I have attached the link of neurological examination. Kindly take a look. Investigations https://youtu.be/PA-KRbrjFsE

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History and physical findings are suggestive of paroxysmal/ Episodic ataxia. Your question can it be MS.Unlikely because MRI shows only atrophic changes in the cerebellum.Looks like Cerebellar disorder,Genetic. Any family history of cerebellar disorder?.Sporadic onset can occur. I hope he is not ethanolic, you mentioned no substance abuse.

Mam no family history or substance abuse.. Thanks a lot mam..
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Brain stem stroke syndrome Lacunar infarct in brain stem Opinion of neurologist Aspirin 150 od clopidogrel 600 stat then 150 od Atorva80 mg od Lmwh bd

As per history and examination pt is having pancerebellar ataxia. Evaluation must be for acquired and genetic causes for same..!!!!

Sir what can be the cause of recurrence and associated slurring of speech??
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Pseutumour cerebri,normotensive hydrocephalus,drainage procedure

recommend the mri if focal lesion appear in brain then start the stat clopidogeral 600mg and start the paravas as 50 od with citicoline 500 mg od

Neurologist openion required..

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