Alcoholic Cerebellar Degeneration

The patient is a 72 year old woman who presented with a 4 year history of progressive difficulty with balance, frequent falls and unsteadiness walking. She required a cane to steady herself. Past History: Significant for alcohol abuse. In 1980, she came to Boston for a second opinion and was seen in consultation by Dr Raymond Adams. Neuro-ophthalmological examination: Visual acuity, visual fields, pupils and fundus examination normal. Ocular motility: •Square wave jerks •Saccadic hypermetria, right gaze to center and left gaze to center •Horizontal gaze evoked nystagmus •Saccadic horizontal pursuit •Smooth vertical pursuit •A mild eso deviation of the eyes Neurological examination: Motor strength normal Reflexes 1+ symmetric Absent ankle jerk, plantar responses flexor Co-ordination: Slight titubation No limb ataxia Trunkal ataxia Gait ataxia Inability to tandem walk Hematological studies: Metabolic workup and liver function tests normal Diagnosis: Alcoholic cerebellar degeneration Treatment: The patient received intravenous thiamin and nutrition counseling prior to discharge. See also: http://content.lib.utah.edu/cdm/ref/collection/ehsl-shw/id/74