Posterior Fossa Lesions

Presenting Symptoms: Incoordination of fingers and leg; slurring of voice. 7/26/79: 57 year old male whose difficulty began in 1973 with gait disturbance and incoordination of hand; progressive to date with scanning speech. Present visual complaint is movement of object in environment to side gaze when shifting gaze from right to left. Illustrated movement is in the direction of gaze; has had to give up driving because of this. Family History: Father had unsteady gait and probably had the same entity but he died of kidney infection. One paternal cousin has same difficulty as patient and one brother has diagnosis as multiple sclerosis. Exam: considerable adiadokinesia (more on right side). Slight nystagmus. on lateral gaze to either side and minimal vertical nystagmus on up gaze +++ dysmetria horizontal to either side (probably accounts for illustrative movement) and on down gaze but not on up gz. Pursuit movement saccadic and poor vestibular suppression. Poor horizontal optikokinetic response but good vertical optikokinetic may be better to rt (tho' poor) than to left. Impression: Pure cerebellar signs although patient was referred to as a extrapyramidal syndrome. Anatomy: Posterior cranial fossa. Pathology: Lesions of posterior cranial fossa. Disease/ Diagnosis: Posterior Fossa Lesions