Course 3, Case 4
Kas 3-4E: Sudden headache, vertigo, gate and stance disturbance
Male, 74 years old. Retired, former sportsman
Admitted to the Intensive care unit of the Department of Neurology due to an acute dizziness
and a repeated vomiting. The symptoms were elicited by bending forward when he attempted
to tie the laces.
Family history: Father died with 29 years on peritonitis. Mother died 71 years old on stroke.
3 children are healthy.
Personal history: Hypertension since 10 years, he takes medicines regularly. State after a
hernia surgery in childhood. Common child diseases.
Actual illness: Sudden onset of an articulation disturbance, noisy tinnitus in the ears, nausea,
repeated vomiting, failure of balance with tendency to the right. During hospitalization there
were intermitent periods of interchanging sinus rhythm bradycardia below 40/min with
paroxysmal atrial fibrilation accompanied by a faster ventricular frequency.
Objective findings: Blood pressure: 170/100
Oriented, dysarthria, repeatedly vomiting.
Head: pupills isocoric, well reacting to light. Eyebulbes slightly divergent due to a temporal
deviation of the right bulb. A dysharmonic nystagmus bilaterally. Less effective facial
motions left. Remaining cranial nerves unconspicuous.
In further neurological examination drop in Migazzini on the right upper as well as lower
extremity by 30 cm. Severe dystaxia of right-sided extremities, dysdiadochokinesis. Astasia
abasia – failure to stand upright. No sensitivity deficits.
Acute CT of the brain: Haemorrhage in the right cerebellar hemisphere, perifocal edema
with pressure on the brainstem.
Questions and tasks:
1. Explain the syndromological diagnosis.
2. Explain the etiopathogenesis.
3. Which other cerebellar disease, or cerebellar syndromology do you know?
4. What are the basic brain stem syndromes?
5. Pathology: intracerebral haemorrhage, its types and causes
6. PF: Cerebellar and brain stem disturbances