Slowly progressive ataxia, neuropathy, and oculomotor dysfunction.

Justin T Jordan, Gincy Samuel, Steven Vernino, Srikanth Muppidi
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引用次数: 3

Abstract

A 54-year-old white man presented with slowly progressive incoordination and weakness. He had normal motor development until, at 16 years of age, he noted difficulty walking and difficulty reading despite normal visual acuity. By the fourth decade of life, he developed poor coordination and balance, as well as inability to walk. In subsequent years, he developed progressive, painless sensory loss, weakness, and atrophy in his distal arms and legs. His vision problems progressed and he also developed dysarthria without dysphagia. Family history was negative except for an uncle who was described as "clumsy." Results of an oculomotor examination were notable for increased square-wave jerks, persistent bilateral gaze-evoked nystagmus with saccadic pursuit, intact vestibulo-ocular reflex, and saccadic dysmetria. He had a mixed dysarthria with flaccid and ataxic characteristics and severe weakness and atrophy in the distal limb muscles. Sensation was diminished to the midforearms and midthighs in all modalities. Deep tendon reflexes were absent throughout, with no response to plantar stimulation. He had marked appendicular ataxia with mild axial ataxia. Magnetic resonance imaging of the brain revealed severe cerebellar atrophy. Results of an electrodiagnostic study suggested a severe axonal sensorimotor polyneuropathy with active and chronic denervation. The differential diagnosis in a patient with ataxia, neuropathy, and oculomotor features is discussed; a methodical approach to the diagnostic workup is suggested; and the final diagnosis is revealed.

缓慢进行性共济失调、神经病变和眼球运动功能障碍。
一名 54 岁的白人男子因缓慢进行性不协调和虚弱而就诊。他的运动发育正常,直到 16 岁时,尽管视力正常,他却发现行走困难和阅读困难。到了第四个十年,他出现了协调和平衡能力差以及无法行走的症状。在随后的几年里,他的手脚远端逐渐出现无痛性感觉缺失、无力和萎缩。他的视力问题不断恶化,还出现了构音障碍,但没有吞咽困难。除了一个被描述为 "笨手笨脚 "的叔叔外,他的家族病史均为阴性。眼球运动检查结果显示,他的方波抽动增加,双侧持续性凝视诱发眼球震颤,伴有眼球追视,前庭眼反射完好,眼球追视障碍。他有混合性构音障碍,伴有弛缓和共济失调特征,四肢远端肌肉严重无力和萎缩。所有模式的感觉都减弱到前臂中部和大腿中部。深腱反射全部消失,对足底刺激没有反应。他有明显的关节共济失调,伴有轻微的轴性共济失调。脑部磁共振成像显示小脑萎缩严重。电诊断研究结果表明,他患有严重的轴索感觉运动多发性神经病,并伴有活跃的慢性神经支配。本文讨论了共济失调、神经病变和眼球运动特征患者的鉴别诊断,提出了有条不紊的诊断方法,并揭示了最终诊断结果。
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来源期刊
Archives of neurology
Archives of neurology 医学-临床神经学
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