Rapidly Progressive Cerebellar Hemiataxia With High Levels Of Gad65 Reactive Antibodies

A 68-year-old woman presented to our hospital because of dizziness, clumsiness, and gait deviation, all of which having progressed over a period of two months. Her medical history was notable for non-insulin dependent diabetes, arterial hypertension, and hepatitis C infection, the latter having been treated successfully with a sixteen week regimen of ombitasvir, paritaprevir, ritonavir and ribavirin two years prior. Daily medications included amlodipine, bisoprolol, metformin, sitagliptin, and aspirin. She was well oriented, with intact speech and cognitive functioning. Cranial nerve examination was normal except for a mild gaze-evoked nystagmus. Strength and muscle tone were normal. She had a mildly ataxic heel-to-shin test on the right. There were no sensory deficits. Deep tendon reflexes were normal in the upper limbs and reduced in the lower limbs, with flexor plantar responses. Shoulder mobilisation on the right was limited and painful. Magnetic Resonance Imaging (MRI) of the brain and spinal cord was unremarkable. Routine blood tests were normal apart from an elevated erythrocyte sedimentation rate of 51 mm/h. A diagnosis of adhesive shoulder capsulitis was made, and the patient was referred to physical therapy.This article is protected by copyright. All rights reserved.