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Ataxia (and Dysmetria)
Published in Alexander R. Toftness, Incredible Consequences of Brain Injury, 2023
These difficulties with planned movement, especially with the hands and eyes, can be described in terms of dysmetria. Dysmetria is a difficulty in moving a body part to the intended position. For example, dysmetria may include moving a muscle too far or not moving it enough. Trying to pick up a glass of water may result in knocking the glass over by moving the hand too far. If a person tries to move their eyes to look at something, they may not move their eyes far enough and therefore fail to look at the thing. Moving a muscle too far is called hypermetria, while not moving it far enough is called hypometria (Timmann & Diener, 2003). The person may need to readjust their hand or eye position multiple times. Dysmetric movements exist both in large movements, such as in the legs, and in small movements, such as in the fingers, and are more inaccurate when movement is attempted quickly (Hore et al., 1991).
Neurological Examination of Malingering
Published in Alan R. Hirsch, Neurological Malingering, 2018
Jose L. Henao, Khurram A. Janjua, Alan R. Hirsch
The finger-to-nose test is used to detect dysmetria. In this test patients are asked to touch their nose with the tip of their index finger, followed by reaching out to touch the examiner’s finger. When repeating this process the examiner will place his or her finger at different locations for the patient to touch. In true ataxia, patients will produce a side-to-side oscillating tremors which is not smooth and increases with amplitude distally, but eventually they will touch the examiner’s index finger. Malingerers dissimulate, as if unable to touch their finger to their own nose (Figure 3.12a). They may circle around the nose with wandering movements which would eventually lead them to touching the very tip of their nose (Figure 3.12b). Making exaggerated movements while being able to touch the tip of the nose is difficult compared to the normal performance of the finger-to-nose to test. Some patients may constantly tap one part of the face to demonstrate that they cannot touch their nose (Figure 3.12c). These positive findings can invoke suspicion for malingering (Campbell, DeJong, and Haerer, 2005).
Discussions (D)
Published in Terence R. Anthoney, Neuroanatomy and the Neurologic Exam, 2017
Some other authors, however, define dysmetria so narrowly that it seems to include only hypermetria. For example, Gilroy and Meyer equate “dysmetria” with “past pointing” (1979, p. 54), as does Chusid—“Dysmetria (past-pointing phenomenon)” (p. 197). One recent medical dictionary also contains a similar definition of “dysmetria”: “A form of dysergia in which the subject is unable to arrest a muscular movement at the desired point” (Hensyl, 1982, p. 433).
Effects of hyperhomocysteinemia on ischemic cerebral small vessel disease and analysis of inflammatory mechanisms
Published in International Journal of Neuroscience, 2021
Liming Cao, Yi Guo, Zhishan Zhu
Patients with ischemic WML were aged from 31–90 years old and had no serious infection at the time of the study, no history of severe craniocerebral trauma, malignant tumors, or organ failure (e.g. heart, liver, kidney, lung, or other), no serious disease leading to a terminal state, no currently active immune disease, and no WMLs caused by poisoning, hereditary degeneration, metabolic diseases, or hydrocephalus were included. Patients with dysarthria-clumsy hand syndrome (DCHS) met the following criteria [12]: dysarthria without dysphasia; unilateral “central” facial weakness with ipsilateral clumsiness appearing as a cerebellar-type ataxia (dysmetria, dysrhythmia, dysdiadochokinesia, gait ataxia) or mild or no weakness; and no sensory symptoms or signs. The other lacunar syndrome group included all patients with LI, with the exception of DCHS. This study was approved by the Ethics Review Committee of the 3rd Affiliated Hospital of Shenzhen University (approval no. 2018LHYYSJNL-003-01), and written informed consent was obtained from all patients (or their parents or guardians).
Morphologic characterization of the anterior inferior cerebellar artery: a direct anatomic study
Published in Neurological Research, 2020
L.E. Ballesteros, P.L. Forero, H.Y. Estupiñan
The AICA occlusion results in a syndrome that mainly compromises the cerebral stem and the middle cerebellar peduncle, present in wide clinical presentations that may include: paralysis of the facial and vestibulocochlear nerves caused by the involvement of the nerves and their nuclei; vertigo, nausea, vomiting and nystagmus caused by injuries of the vestibular nuclei and their connections to the nuclei of the decimal cranial nerve, ipsilateral anaesthesia and thermal analgesia on the face and corneal hypoesthesia, caused by interruption of the trigeminal fascicle; Horner’s syndrome determined by the interruption of the descending pupil dilating nerve fibers located on the lateral portion of the pons and the medulla oblongata; hypoesthesia and thermal analgesia in the contralateral hemi body due to compromise of the lateral spinothalamic fascicle [19]; also, cerebellar ataxia and asynergy attributed to a lesion in the lower cerebellar peduncles [4,20–23]. Furthermore, dysarthria, ipsilateral dysmetria may also occur. Additionally, a loss of ipsilateral conjugate gaze as a consequence of flocculus involvement. Finally, it is worth mention that infarctions of the AICA territory are rare and often misdiagnosed [24].
Emergency surgery for brainstem cavernoma haemorrhage with severe neurological presentation. Is it indicated and worthwhile?
Published in British Journal of Neurosurgery, 2020
Cristiano M. Antunes, Renata S. F. Marques, Maria J. S. Machado, Leandro T. M. Marques, Miguel A. R. Filipe, João S. Fernandes, Carlos M. G. Alegria
This 31-year-old female’s symptoms started with right-side hypoesthesia, ataxia and diplopia. After one month of the onset of the symptoms, she was investigated with head CT and MRI, which revealed a pontomesencephalic cavernoma with evidence of recent haemorrhage (Figure 5(a)). She was initially treated ‘conservatively’ but, after four days, she suddenly developed a severe headache, nausea and vomiting, depression of conscious level to GCS 13 (O3V4M6) and MRI showed there was an increase in hematoma volume (Figure 5(b)). She was then emergently operated through IV ventricle floor with ultrasonography support after EVD placement at Frazier’s point. The hematoma and cavernoma were removed (Figure 5(c)). She was admitted to the Intensive Care Unit for a short period. She was discharged to rehabilitation with progressive improvement. She was operated on by the Ophthalmology to correct diplopia caused by III nerve paresis and VI nerve palsy. At the last follow-up, she was able to walk with support despite residual right-side ataxia and a grade 4 right-side hemiparesis. She had severe right-side dysmetria – mRankin 4.