EpistemisDysmetria
Specialty: Neurology.
Why it occurs
- Cerebellar stroke (ischemia or hemorrhage in the territory of the PICA, AICA or SCA)
- Multiple sclerosis (demyelinating plaques in the cerebellum or cerebellar peduncles)
- Acute intoxication by ethanol or other toxic substances (lithium, phenytoin, carbamazepine)
- Spinocerebellar cerebellar atrophy (autosomal dominant or recessive hereditary ataxias)
- Cerebellar paraneoplastic syndrome (associated with small cell lung, ovarian or breast cancer due to anti-Yo, anti-Hu antibodies, etc.)
Initial workup
Performing the finger-nose and heel-knee maneuvers to verify hypermetry or hypometry; Posterior fossa brain MRI (study of choice superior to posterior fossa CT due to less bone artifact); panel of paraneoplastic antibodies in serum and CSF; toxicological screening; antiepileptic drug levels.
red flags
Unilateral dysmetria of sudden and apoplectic onset accompanied by intense occipital headache, repeated vomiting, vertigo, dysarthria and nystagmus, which strongly suggests hemorrhage or acute cerebellar infarction with risk of compression of the fourth ventricle and tonsillar hernia.
Standard management
- Suspension of drugs causing cerebellar toxicity
- Methylprednisolone IV — if it is a multiple sclerosis outbreak
- Intravenous immunoglobulin or plasmapheresis if a paraneoplastic or antibody-mediated autoimmune origin is suspected
- Support management and intensive cerebellar coordination physiotherapy.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Neurology
- Listed causes
- 5
- Treatment options
- 4