karusmle
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68 , year old , with 30 pack year history of smoking presents to the physcian with difficulty walking.he states that it has gotten progressively worse over the past month.his wife says that he walks as if he were drunk,frequently stagerring and losing his balance,but the man denies alcohol use.he also notes that he has had frequent headaches,that seems to be getting worst.neurologic examination reveals a wide based gait and a tendency to fall to the right.HE SHOWS NO ATAXIA ON FINGER TO NOSE OR HEEL TO SHIN TESTING.RAPID ALTERNATING MOVEMENTS ARE NORMAL.WHAT IS THE MOST LIKELY LOCATION OF THIS MAN'S LEISION????
guys i thought of cerebellum untill i read the words that i have highlightened in capital , then my mind got stuck.............anyway the answer is cerebellum, r'nt the coordination tests that i mentioned in capital words would be abnormal in cerebellar defects??????i remember reading like this in my final year .............. i need an explanation desperately for this .........can sombody help me plz............
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| Shakeels
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I think its hemorhagic destruction of contralatral sub thalamic nucleus, where he has hemibalismus towards the contralateral side, and the cause is hyertension, thas why he got head aches.
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| bluecatback
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The location of the lesion is the VERMIS of cerebellum.
The HEMISPHERE of cerebellum is fine.
Edited by bluecatback on 11/29/05 - 12:09 PM
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| Shakeels
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Do you mean truncal ataxia bluecatback???
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| bluecatback
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Yeah, the patient has "trunk ataxia", but no "limb ataxia". Thus, only the vermis of hemisphere is destructed.
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| gd11
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that is trunk ataxia and is due to a lesion of the cerebellar vermis as opposed to a lesion of the cerebellar hemispehere that would produce limb ataxia
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| neo335
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i agree with bluecatback n g11.... i too remember reading in the q-bank somewhere..... yes, i think.... vermis lesion is the coz.. n hemeisphere is fine....
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| aonty
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1) anterior vermis syndrom:
cause:alcoholism (but the person denies alcohol use)
feature:atrophy of rostral vermis
symptoms:leg,trunkal,gait dystaxia
2) posterior vermis syndrom: involves the floculonodular lobe
cause:medulloblastoma ,ependymoma
symptoms:trunkal dystaxia
3) hemispheric syndrom:
cause: tumor, abscess(due to otitis media or mastoiditis)
symptoms:
1) ipsilateral cerebellar dysfunction
( muscle hypotonia,dysequlibrium,dysynergia)
2) leg,arm,gait dystaxia
but wat i cant accomodate is his headach y is he having headach 
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| karusmle
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thank u guys.............
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| gd11
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headaches secondary to increased intracranial pressure or concomitant pathology
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| Shakeels
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Well guys you are absolutely right, I'm sorry for putiing wrong diagnosis. I was thinking about CSN bcz he has more tendency to fall towards right, and he has got sever headaches and he also said about losing balance towards one side.
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