Case Challenge: A Woman with Ataxia and Abnormal Uterine Bleeding

We present a neurological case. What's the diagnosis? How you would evaluate the patient?

A 46-year-old, right-handed woman presented with a 7-day history of sudden onset of headache, nausea, photophobia, and phonophobia. In the last 3 days, she reported an involuntary tendency to fall to one side, difficulty walking, and slurred speech. There were no previous behavioral or mental disorders; she denied fever, alcohol abuse, and any other substance abuse or recent immunizations. Her medical history was remarkable for migraine and 2 months of abnormal uterine bleeding and pelvic pain.

The patient's general physical examination was normal. Blood pressure was 120/75 mm Hg, pulse 85 beats per minute, respiratory rate 20 breaths per minute, and temperature 36.5°C (97.7°F). Neurological examination revealed slurred speech with normal co…

Video 1: Hypermetric Saccades0:34

Video 3: Abnormal Heel-Knee-Shin Test0:27

Video 2: Pendular Reflexes0:28

Video 4: Wide-Based, Ataxic Gait0:23

Authors

Jaime Toro, MD

Disclosures

Editorial BoardsMultiple Sclerosis and Related Disorders

Jaime Toro, MD

Disclosures

Editorial BoardsMultiple Sclerosis and Related Disorders

David Cuellar-Giraldo, MD

Saúl Reyes, MD

Lina Quintero, MD

Nicolas Lemus, MD

Maria I. Reyes-Mantilla, MD

Case Challenge: A Woman with Ataxia and Abnormal Uterine Bleeding

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