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Spinocerebellar Ataxia with Rigidity and Peripheral Neuropathy


Presentation

  • We present to you such an unusual and uncommon presentation of falciparum malaria.[casereports.in]
  • Movement disorders are group of neurological diseases presented with hypo- or hyperkinetik movements. Parkinsonism present hypokinetik, while dystonia, chorea, athetosis, balism, ticks and myoclonus present hyperkinetik movements.[medcraveonline.com]
  • SCA 3 can present as levodopa responsive dystonia phenotype. Awareness of the atypical presentations of SCA3 has diagnostic and therapeutic relevance.[pmj.bmj.com]
  • Although the combination of spinocerebellar ataxia and motor neuron disease is very rare, the present case suggests the inter-relation of the spinocerebellar and motor neuron systems, and presents peripheral neuropathy as a subtype of multisystem atrophy[the-medical-dictionary.com]
  • […] skew deviation absent present absent Nystagmus often present acutely peripheral type often present central type absent Peripheral proprioceptive sensory deficit absent absent present Romberg’s test may be present if there is a bilateral vestibulopathy[lifeinthefastlane.com]
Increased Susceptibility to Infections
  • susceptibility to infections Oculomotor apraxia Progressive ataxia and slurred speech Susceptibility to cancer (eg, leukemia, lymphoma) Laboratory findings Molecular genetic testing is performed for mutations affecting the ATM gene locus (11q22.3).[emedicine.medscape.com]
Constipation
  • Constipation and pollakisuria suggested an autonomic system involvement.[the-medical-dictionary.com]
  • Added to this are gastroparesis, constipation, vomiting, and intermittent diarrhea with abdominal pain. Many individuals develop diverticulosis and diverticulitis that may lead to intestinal perforations.[disorders.eyes.arizona.edu]
Skin Lesion
  • lesions or rashes, or musculoskeletal abnormalities multi-system involvement (in addition to the CNS) Appendix Romberg’s test – the test is primarily used to differentiate sensory ataxia from cerebellar ataxia – Romberg’s sign detects proprioceptive[lifeinthefastlane.com]
  • lesions -- 6p12.3-q16.2 Spinocerebellar ataxia (SCA35) OMIM #613908 Upper limb involvement and torticollis -- 20p13 Mutation in the TGM6 gene Spinocerebellar ataxia (SCA36) OMIM #614153 Truncal instability Dysarthria Dysdiadochokinesis Hyperreflexia[emedicine.medscape.com]
Macula
  • Fundus changes were minimal with a bull’s eye pattern of pigment changes in the macula described as indicative of a rod-cone congenital amaurosis. ERG responses were unrecordable.[disorders.eyes.arizona.edu]
  • […] expanding to encompass an increasing portion of a visual hemifield Foster-Kennedy syndrome ipsilateral anosmia, ipsilateral optic atrophy, and contralateral papilledema due to frontal lobe or olfactory groove mass lesion fovea center most part of the macula[strokecenter.org]
Visual Hallucination
  • Core clinical features are fluctuating cognitive impairment (50-75%), visual hallucinations, and parkinsonism (seen in 25-50% of patients at diagnosis).[quizlet.com]
  • Within a year of onset severe motor handicaps develop along with some degree of dementia with aggression and visual hallucinations. Cognitive decline is often a feature.[disorders.eyes.arizona.edu]
  • In simple partial seizures, consciousness is retained and abnormal sensations, visual hallucinations, or local muscle contractions occur.[britannica.com]
  • hallucinations, and parkinsonism and defined pathologically by cortical (as well as nigral) Lewy bodies diplegia see paraplegia diplopia double vision dissociated sensory deficit impairment of pain/temperature sensation with preservation of vibration[strokecenter.org]
Sexual Dysfunction
  • Other complications of ataxia may include: Dizziness Spasticity Rigidity Tremor Pain Fatigue Low blood pressure with sitting or standing Bowel or bladder dysfunction Sexual dysfunction Many things can be done to improve the quality of life of the person[hopkinsmedicine.org]
Pollakisuria
Poor Coordination
  • Typically, the most common include: Balance and coordination problems (affected first) Poor coordination of hands, arms, and legs Slurring of speech Wide-based gait (manner of walking) Difficulty with writing and eating Slow eye movements The symptoms[hopkinsmedicine.org]
  • The neurological examination disclosed saccadic eye movement, slurred speech, wide-based and poor tandem walking, poor coordination, hyper-- reaction of both the patellar tendon reflexes, and pollakisuria.[the-medical-dictionary.com]
Delayed Speech and Language Development
  • speech and language development Dysmetria Intellectual disability, severe Intellectual disability, moderate Cognitive impairment Truncal ataxia Intention tremor Intellectual disability, mild Dysdiadochokinesis Spasticity Strabismus Autosomal dominant[mendelian.co]
Upbeat Nystagmus
  • nystagmus is usually seen in cerebellar vermis lesions or intra-axial midline brainstem lesions) – other more bizzare forms of nystagmus can also be seen eg. periodic alternating nystagmus, pendular nystagmus, divergent nystagmus, pure torsional nystagmus[lifeinthefastlane.com]
Fine Tremor
  • Fine tremors in the chin may be seen along with other extrapyramidal signs but these are not prominent in the limbs. Instead there is often rigidity and bradykinesia. Dysphagia, dysarthria, and ataxia are features in many patients.[disorders.eyes.arizona.edu]
Pendular Nystagmus
  • nystagmus, divergent nystagmus, pure torsional nystagmus on vertical gaze (* see the nystagmus guidemap for more details on nystagmus) – gaze apraxia (problems re-directing gaze with normal extraocular apparatus function) is seen in certain hereditary[lifeinthefastlane.com]

Workup

  • […] in the ED for a stable patient with an acute cerebellar syndrome can be initiated following consultation with a neurologist, and the workup may include blood tests (including heavy metals, serum ETOH and anticonvulsant drug levels), neuroimaging to exclude[lifeinthefastlane.com]
  • […] on nervous system parastheias ataxia lower limbs progresses to spastic weakness memory problems irritability apathy confusion dementia, depression, sleepiness impaired vision paraplegia (late in the course) B12 should be part of dementia/ depression workup[quizlet.com]

Treatment

  • Treatment Treatment Options: No treatment has been reported.[disorders.eyes.arizona.edu]
  • […] the other listing requirements despite this treatment.[ssa.gov]
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you. Know why a new medicine or treatment is prescribed, and how it will help you.[hopkinsmedicine.org]
  • The treatment in oral anticoagulation-associated intracerebral hemorrhage includes: 108. The treatment of brain edema in an intracerebral hemorrhage includes: 109. Basic treatment measures in an intracerebral hemorrhage include: 110.[fmed.uniba.sk]
  • From the Hazard Gazette comes SIRT2 as a future treatment target for HD This is just a quick post on a recent paper in Lancet Neurology which looked at the potential benefit of Riluzole in the treatment of cerebellar ataxia.[theneurologylounge.com]

Prognosis

  • The prognosis is poor and patients rarely improve.[bloodjournal.org]
  • Prognosis [ edit ] There is currently no cure for SCA 6; however, there are supportive treatments that may be useful in managing symptoms. Epidemiology [ edit ] The prevalence of SCA6 varies by culture.[en.wikipedia.org]
  • The prognosis is usually bad with survival rates less than a few years after onset.[neuroweb.us]
  • This disorder also has a poor prognosis.[emedicine.medscape.com]

Etiology

  • Diagnostic criteria of PNSs The presence of a neurological syndrome of unclear etiology at the time of the diagnosis of a tumor does not necessarily mean that the neurological syndrome is paraneoplastic, as this could represent the coincidental occurrence[bloodjournal.org]
  • Bowman KM, Goodhart R, Jolliffe N (1939) Observation on the role of vitamin B1 in the etiology and treatment of Korsakoff psychosis. J Nerv Ment Dis 90:569–575 CrossRef Google Scholar 17. Jolliffe N, Wortis H, Fein HD (1941) The Wernicke sindrome.[link.springer.com]
  • The etiology of multiple system degenerative diseases is not known. However, we speculate that this unusual combination of system degeneration was not a mere coincidence, but possibly a unique subtype of multisystem atrophy.[the-medical-dictionary.com]
  • Etiology- IgA/IgG Anti-Gliadin Ab, Anti-endomysial Ab and Ab against Tissue Trans-glutaminase Rx-Gluten free diet, I.V.[slideshare.net]
  • The most frequent etiological agent of neuroborreliosis in Europe is: 30. Diagnosis of borreliosis is supported or confirmed by: 31. Which of the following statements about the Lyme Borreliosis are TRUE? 32.[fmed.uniba.sk]

Epidemiology

  • Received : 26.2.2000; Revised : 29.7.2001; Accepted : 30.6.2001 Abstract Aims of the study : As per WHO (1993) the assessment and analysis of local problems and an appropriate epidemiological information system is an essential part of a control programme[japi.org]
  • ., Risk factors for falls in community-dwelling older people: A systematic review and meta-analysis, Epidemiology 21 (2010), 658–668. [7] K. Delbaere, J.C. Close, A.S. Mikolaizak et al., The Falls Efficacy Scale International (FES-I).[epub.ub.uni-muenchen.de]
  • Epidemiology [ edit ] The prevalence of SCA6 varies by culture.[en.wikipedia.org]
  • The Global Epidemiology of Hereditary Ataxiaand Spastic Paraplegia: A systematic review of prevalence studies. Neuroepidemiology 2014; 24:174-183. Ashizawa T, Figueroa KP, Perlman SL, et al.[rarediseases.org]
Sex distribution
Age distribution

Pathophysiology

  • […] it difficult to classify some of these patients according to the existing system of OPCA classification due to the heterogeneity in the clinical features, and recommended further genetic and molecular studies to identify the underlying cause and the pathophysiology[cags.org.ae]
  • Subramanian R, Khadori R (2000) Severe hypophosphatemia: pathophysiologic implications, clinical presentations, and treatment. Medicine 79:1–8 PubMed CrossRef Google Scholar 30.[link.springer.com]
  • Pathophysiology [ edit ] Most cases of SCA6 are a result of CAG repeat expansion beyond the normal range, i.e., more than 19 repeats, in the Ca v 2.1 calcium channel encoding gene CACNA1A. [1] This gene has two splice forms , "Q-type" and "P-type", and[en.wikipedia.org]
  • Deuschl G, Lucking CH, Quintern J (1987) Orthostatic tremor: clinical aspects, pathophysiology and therapy. EEG EMG Z Elektroenzephalogr Elektromyogr Verwandte Geb 18:13–19 PubMed Google Scholar 9.[springerlink.com]
  • […] patients with SCA6 complained of episodic headache by contrast with patients with episodic ataxia type 2 32 The pathogenic mechanism induced by expanded CAG repeats is supposed to be a gain of function probably mediated by associated proteins. 33 However, pathophysiology[jnnp.bmj.com]

Prevention

  • ., Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus, J Am Geriatr Soc 53(9) (2005), 1618–1622. [23] T. Lempert, J. Olesen, J.[epub.ub.uni-muenchen.de]
  • Collaborative Meta-Analysis of Randomised Trials of Antiplatelet Therapy for Prevention of Death, Myocardial Infarction, and Stroke in High Risk Patients. ‎[books.google.es]
  • Self-Care Instructions Preventing falls Home safety; Safety in the home; Fall prevention Self-Care Instructions Preventing head injuries in children Concussion - preventing in children; Traumatic brain injury - preventing in children; TBI - children;[mountsinai.org]
  • Prevention/Screening [ edit ] There is no known prevention of spinocerebellar ataxia. Those who are believed to be at risk can have genetic sequencing of known SCA loci performed to confirm inheritance of the disorder.[en.wikipedia.org]

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