1. What is the term for this patient’s findings when he attempted to sit on the side of the bed?
Truncal ataxia
2. Indicate the possible locations of the neurologic lesion and the side of the lesion. Indicate the specific structures involved by the pathologic process.
Signs or Symptoms Site of Lesion Localization
Vertigo Right inner ear vs vestibular nerve Right flocculonodular lobe
vs flocculonodular lobe of the cerebellum
Fall/veer to the right, Same
with truncal ataxia Cerebellar vermis
3. What type of pathologic process do you think is involved in this case? If vascular, indicate the appropriate vessel.
Vascular. Right PICA (cerebellar branches)
Pathologic Dx
Right PICA infarction of the cerebellum involving primarily the flocculonodular lobe and the posterior-inferior vermis
4. What diagnostic procedure(s) would you undertake at this point?
References:
1. Duncan GW, Parker SW, Fisher CM. Arch Neurol 1975;32:364-368.
2. Lee H, Sohn S-I, Cho Y-W, Lee S-R, Ahn B-H, Park B-R, Baloh RW. Neurology 2006;67:1178-1183.
3. Chen W, Fang, J, Dong YR, et al. Neurology 2011;77:e122.