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Unsteadiness – Neither Cerebellar Nor Vestibular

  • Ross Nortley
  • Zane Jaunmuktane
  • Sebastian Brandner
  • Hadi Manji
Chapter

Abstract

A 61 year old man presents with slowly progressive balance difficulties and numbness in the lower limbs. Neurological examination is consistent with a sensory ataxia. Investigations reveal positive anti-GD1b antibodies with modestly elevated CSF protein. EMG and nerve conduction studies demonstrate a mild large-fibre axonal motor-sensory neuropathy with no demyelinating features. MRI reveals bilateral thickening of the lower brachial plexus with possible enhancement of affected nerves. Lower limb SSEPs are undetectable and prove to be the key investigation in localising the region of pathology to make a diagnosis.

Keywords

Acquired inflammatory polyradiculopathy Dorsal columns Dorsal root entry zone Dorsal roots Dorsal root ganglia Proximal sensory immune polyradiculopathy Sensory nerves Sensory ataxia Somatosensory evoked potentials (SSEPs) 

References

  1. Chhetri SK, Gow D, Shaunak S, et al. Clinical assessment of the sensory ataxias; diagnostic algorithm with illustrative cases. Pract Neurol. 2014;14:242–51.CrossRefPubMedGoogle Scholar
  2. Sinnreich M, Klein CJ, Daube JR, et al. Chronic immune sensory polyradiculopathy: a possibly treatable sensory ataxia. Neurology. 2004;63:1162–9.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Ltd. 2017

Authors and Affiliations

  • Ross Nortley
    • 1
  • Zane Jaunmuktane
    • 2
  • Sebastian Brandner
    • 2
  • Hadi Manji
    • 1
  1. 1.MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and NeurosurgeryLondonUK
  2. 2.UCL Institute of Neurology and The National Hospital for Neurology and NeurosurgeryLondonUK

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