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A 60-Year-Old Man With Progressive Ataxia

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A 60-Year-Old Man With Progressive Ataxia

Case History


A 60-year-old man presents with a 2-month history of difficulty balancing, which came on gradually and has progressively worsened. The patient has been deaf for 20 years but can lipread. He reports that symptoms are worse in the dark, and he reports no numbness or tingling in the feet.

On examination, the patient was alert and cooperative but had trouble understanding commands. Mild heel-to-shin and finger-to-nose ataxia was seen and Romberg's test was positive. Propioception of the feet was normal; however, the patient demonstrated a slight wide-based gait.

The following magnetic resonance imaging (MRI) scans were obtained (Figures 1 and 2).


Figure 1. T2-weighted magnetic resonance imaging scan #1.

Figure 2. T2-weighted magnetic resonance imaging scan #2.


Questions answered incorrectly will be highlighted.

Based on the above history and imaging, what is this patient's most likely diagnosis?

Mitochondrial disease

Superficial siderosis of the brain

Fragile-X premutation

Tremor ataxia syndrome

Neurosyphilis




Source...
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