ro13-9904 and Cerebellar-Ataxia

Neurosyphilis has become an uncommon diagnosis in the current era. Neurological manifestations of syphilis usually lie within the spectrum of meningovascular syphilis, tabes dorsalis or general paresis of the insane. Although sensory ataxia may occur as part of spinal cord involvement, cerebellar ataxia has been rarely described as a manifestation of neurosyphilis. In this report, we describe a rare case neurosyphilis presenting in the form of a pure pancerebellar syndrome of subacute progression.

Topics: Anti-Bacterial Agents; Ceftriaxone; Cerebellar Ataxia; Diagnosis, Differential; Dysarthria; Gait Ataxia; Humans; Male; Middle Aged; Neurosyphilis; Physical Therapy Modalities; Treponema pallidum

Leptospirosis involves nervous system in around 10-15% of the cases, the commonest presentation being aseptic meningitis. Most of the clinical features of neuroleptospirosis are due to capillary endothelial damage and vasculitis. Ataxia is an extremely uncommon manifestation of Leptospirosis occuring in <5% of cases.. A 28 year old female from North India presented with a short febrile illness followed by an acute onset cerebellar ataxia, anemia, thrombocytopenia and transaminitis. Leptospira serology showed high titres of IgM (ELISA) and MAT (microscopic agglutination test titre >1:800) . She was treated with intravenous ceftriaxone for 14 days following which she showed marked recovery.. The clinical features of neuroleptospirosis are varied, most of them resulting from endothelial damage and vasculitis. Immune mediated phenomenon with no structural damage is another possible mechanism leading to cerebellar ataxia. Cerebellar ataxia due to common tropical infections should be ruled out in the appropriate setting, as early institution of treatment can abate neurological morbidity. The case report highlights the importance of identifying a reversible cause of cerebellar ataixa due to a tropical infection, possibly due to a immune mediated phenomenon, and would be of interest to both internists and neurologists.

Topics: Adult; Agglutination Tests; Anti-Bacterial Agents; Antibodies, Bacterial; Brain; Ceftriaxone; Cerebellar Ataxia; Enzyme-Linked Immunosorbent Assay; Female; Humans; Immunoglobulin M; Leptospira; Leptospirosis; Magnetic Resonance Imaging

Enteric fever is associated with a variety of clinical presentations and complications. Although central nervous system involvement is not uncommon in enteric fever, acute cerebellar ataxia as a presenting feature is rare. A 7-year-old boy with enteric fever who presented with acute cerebellar ataxia is reported.

Topics: Ceftriaxone; Cerebellar Ataxia; Child; Humans; Male; Typhoid Fever

Whipple disease (WD) is an infectious disease, which may affect the central nervous system. Central nervous system symptoms are eventually present in as many as 43% of the cases. To our knowledge, cerebellar ataxia in WD has never been formally studied in any large series.. To determine the prevalence of cerebellar ataxia in central nervous system WD.. Between January 1974 and December 2003, we identified 11 patients who met criteria for definite central nervous system WD, the second largest series to date. Surprisingly, while oculomasticatory myorrhythmia was recorded in only 1 patient (9%), cerebellar ataxia had been documented in 5 cases (45%).. Our data suggest that cerebellar ataxia should be considered a more common feature of central nervous system WD.

Topics: Adult; Age of Onset; Aged; Ceftriaxone; Cerebellar Ataxia; Cerebellum; Comorbidity; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Minnesota; Prevalence; Sulfamethoxazole; Treatment Outcome; Trimethoprim; Whipple Disease

Central nervous system manifestations represent 0.54 to 8% of neurological complication in Lyme disease.. A 78-year-old woman presented a severe meningo-encephalitis with visual disorders (agnosia, alexia) progressing towards coma. Cranial magnetic resonance imaging revealed large areas of hypersignal T2 in the white matter of the lower, parieto-occipital lobes and left temporal lobe. The cerebrospinal fluid (CSF) contained 16 then 293 white corpuscles/mm3 of lympho-monocytes, increased protein level from 2.67 to 5.83 g/l and an increase in IgG index with oligoclonal distribution of IgG. Serological Elisa analysis for Lyme disease was slightly positive in blood (confirmed by western blot) but clearly in the CSF (IgG and IgM). Treatment with ceftriaxone followed by methylprednisolone provided clinical improvement 3 months later.. Acute meningo-encephalitis is often benign, protein-like and of good prognosis: the gnosic visual disorders with posterior leukoencephalopathy are unusual. A blood level of specific antibodies slightly positive on Elisa at the early stage of the infection warrants confirmation by Western blot in the blood and by Elisa in the CSF. Additional corticosteroid therapy may be required in the severe forms that evoke acute disseminated encephalomyelitis.

Topics: Acyclovir; Aged; Agnosia; Antibodies, Bacterial; Blotting, Western; Borrelia burgdorferi; Ceftriaxone; Cerebellar Ataxia; Cerebral Cortex; Diagnosis, Differential; Dominance, Cerebral; Drug Therapy, Combination; Dyslexia; Enzyme-Linked Immunosorbent Assay; Female; Humans; Immunoglobulin G; Immunoglobulin M; Lyme Neuroborreliosis; Magnetic Resonance Imaging; Methylprednisolone; Neurologic Examination