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Clinical Reasoning: A 28-year-old man with progressive gait disturbance and encephalopathy
A 28-year-old man with sickle cell disease presented with 7 months of difficulty walking. Initial examination 3 months prior to admission to our hospital was thought to be consistent with a polyneuropathy. He was areflexic, was unable to stand on toes or heels with decreased sensation on the left foot to light touch and vibration, had difficulty with heel to shin, and was unable to perform tandem gait. Laboratory tests revealed anemia (hemoglobin 7.2 g/dL) and elevated creatinine (1.49 g/dL). HIV, antinuclear antibodies, antineutrophil cytoplasmic antibodies, hepatitis serologies, rapid plasma reagin, thyroid-stimulating h...
Source: Neurology - December 8, 2014 Category: Neurology Authors: Massaro, A. M., Pruitt, A. Tags: Stroke in young adults, MRI, Gait disorders/ataxia, All Oncology RESIDENT AND FELLOW SECTION Source Type: research

What Causes Ataxia?
Discussion Coordination and balance problems are caused by various problems affecting the central and peripheral nervous system. Normal development of a child or weakness of a child are commonly mistaken for true ataxia. Ataxia specifically refers to “…impairment of the coordination of movement without loss of muscle strength.” If it is purely due to abnormalities of the cerebellum then there should be no changes in mental status, sensation or weakness. Sometimes it is difficult to determine if there are abnormalities in other areas. For example, Guillian-Barre often presents with difficulty or clumsy wal...
Source: PediatricEducation.org - March 31, 2014 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Anti glutamic acid decarboxylase antibody mediated encephalopathy while on etanercept in a patient with multiple autoimmune diseases
A 39 year old lady presented with an altered mental state and unsteadiness of gait. She had a history of juvenile idiopathic arthritis, autoimmune thyroiditis and alopecia, protein S deficiency with vena cava thrombosis, previous excision of ovarian mass and vasculitic rash. There was a previous history of ovarian mass and her immunomodulatory therapy for arthritis over the previous year was Etanercept. She used recreational cannabis but denied any other illicit drug usage. Her affect was variable and at times inappropriate with frequent laughter. She would spit regularly. There was anxiety and a prevailing sensation of do...
Source: Journal of Neurology, Neurosurgery and Psychiatry - October 9, 2013 Category: Neurosurgery Authors: MacDougall, N., Waddell, B., O'Riordan, J. I. Tags: Immunology (including allergy), Brain stem / cerebellum, Drugs: CNS (not psychiatric), Epilepsy and seizures, Infection (neurology), Stroke, Drugs misuse (including addiction), Connective tissue disease, Musculoskeletal syndromes Association of British Source Type: research