Progressive Ataxia and Downbeat Nystagmus in the Adult

A 63-year-old man presented with a history of vomiting, hypertension, dyslipidemia, type 2 diabetes, dilated ischemic cardiomyopathy, alcohol use, and stroke; physical examination found appendicular dysmetria with truncal ataxia and downbeat nystagmus. Brain magnetic resonance imaging revealed a hyperintensity on T2-weighted and fluid-attenuated inversion recovery sequences without reduced diffusion in the cerebellar nodule. What is your diagnosis?
Source: JAMA Neurology - Category: Neurology Source Type: research