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Dr. F
Dr. F, Board Certified MD
Category: Neurology
Satisfied Customers: 266
Experience:  Neurosurgeon with more than 20 years experience in practice and teaching.
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My husband has progressing Ataxia that started 8 months ago

Customer Question

Hi,
My husband has progressing Ataxia that started 8 months ago approximately. He walks like he's drunk. Some day's are better than others but for the most part he always has now a wide based unbalanced gait.
He has been tested for Paroneoplastic syndromes with a blood test (that test came back negative), two MRI's one with dye and one without. All vitamin deficiency test's which are normal. Also a MRI of his cervical spine which was normal. The only finding in the MRI of the brain was small bilateral enchephalomacia, which nuerologist suggested from some trauma in the past. (He has many falls off horses, he had a horse training business).
He has no genetic history of anything like this.
The did blood tests yesterday for hereditary Nuerodegeneration diseases which takes 10 days to come back.
His other symptoms are chronic fatigue, and apathy. He did have some blurred vision several months ago but was primarily and isolated event. He does not have vertigo.
He does have trouble swallowing sometimes, with things like bread etc. he has a severe gag reflex.
He has been a chronic chewing tabbaco user and swallow the spit which has caused severe GERD at times. He does suffer from night sweats occasionally.
He is slightly slower cognitively, but nothing severe.
Any suggestions? Thank you!
Submitted: 4 months ago.
Category: Neurology
Expert:  Dr. Bob replied 4 months ago.

Has he had an LP (lumbar puncture)?

Customer: replied 4 months ago.
No
Expert:  Dr. Bob replied 4 months ago.

I would suggest you ask his doctors to check his CSF (cerebrospinal fluid). This is an important element in ruling out certain infectious causes. For example, progressive adult onset sporadic ataxias may sometimes be caused by chronic infections of the central nervous system. The most common infections related to progressive sporadic ataxia are neurosyphilis, Whipple's disease, Lyme disease and HIV.

Expert:  Dr. Bob replied 4 months ago.

Another possible line of investigation would be immune-mediated ataxias. These are neurological conditions related to auto-immune disorders. Immune-mediated ataxias include: gluten ataxia, ataxia associated with antibodies against the glutamic acid decarboxylase (anti-GAD), steroid-responsive encephalopathy associated with autoimmune thyroiditis and paraneoplastic cerebellar degeneration.

Expert:  Dr. Bob replied 4 months ago.

Alcohol or other toxic exposures may also cause or exacerbate a pre-existing ataxia. The main substances causing toxic ataxia are: lithium, phenytoin, amiodarone, toluene and some chemotherapy’s (5-fluorouracil and cytosine arabinoside). There are also descriptions of ataxia induced by mercury or bismuth subsalicylate exposure. Other drugs may rarely cause cerebellar symptoms: carbamazepine, valproic acid, cyclosporine, isoniazid, metronidazole, nitrofurantoin, procainamide and even statins. When toxic ataxia is suspected, these substances should be immediately discontinued. Clinical outcome is variable after drug cessation: patients may have significant improvement or only stabilization of symptoms.