Case Challenge: A Woman with Ataxia and Abnormal Uterine Bleeding
Jaime Toro, MD, David Cuellar-Giraldo, MD, Saúl Reyes, MD, Lina Quintero, MD, Nicolas Lemus, MD, Maria I. Reyes-Mantilla, MD

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 comprehension, repetition, and nomination. Some hypermetric saccades were seen (video 1, see below). Deep tendon reflexes in the lower limbs were significantly increased, and pendular reflexes were also present (video 2). The patient had bilateral abnormal heel-knee-shin (video 3) and finger-to-nose tests. Her gait was ataxic (video 4)..........


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