Case No 11: Post-Traumatic Cerebellar Ataxia with Sensory Neuropathy.

Ravi reported here with chief complaints of inability to stand and walk independently with deterioration in hand writing skills with unclear speech. There was a history of road traffic accident in 1981 leading to fracture of left femur shaft. It was treated with nailing of fractured femur bone. Subsequently he developed slowness in his walking speed with slurred speech. His NCV study done in 1984 was suggestive of sensory neuropathy. Repeated NCV study done in June 2001 was suggestive of generalized sensory neuropathy with worsening of the neuropathy in lower limbs. His MRI study done in 1991 was suggestive of cerebellar atrophy.

On examination mild stiffness was observed in lower limbs with restricted ankle dorsi - flexion. Functionally standing was possible only with support. Walking was possible with two hands support only with hyper extended knees. Squatting was possible with external support only. He was fairly independent in his activities of daily living. His speech was mildly slurred.

Improvements noted with 4 months of G – Therapy :

1. His recent NCV study done in Oct. 2001 is suggestive of higher amplitude response from right median nerve with other SAPs being still absents.
2. Reduction of pain at knees in standing position.
3. Reduction in involuntary movements of legs at night.
4. Comes independently to supported standing position.