Tremor Ataxia
Episodic involuntary movements, predominantly shaking, and jumping, swinging, trembling, dance-like or gross tremor-like appearance, often involving one limb or a single limb, lasting seconds or minutes, often occurring when lying down to sitting to standing, prolonged standing, and immediately stopping immediately when lying down or sitting down. Abnormalities of the internal carotid artery vasculature.
Jittery TIA limb shaking syndrome (LSS)
Irreversible extrapyramidal syndrome, commonly seen in patients with chronic active hepatitis, alcoholic cirrhosis. MRI features include high signal in the bilateral pallidum, midbrain, perirhinal red nucleus, and anterior pituitary.
Hepatocerebral degeneration
It is common in middle-aged and elderly patients, with slow onset, progressive resting tremor (initially may be on one side), relieved by casual movement, aggravated by agitation, slow movement, muscle stiffness, abnormal posture and gait, and effective with dopamine therapy (early complaints may be of back, neck and shoulder pain, weakness, mild stiffness and slow movement of limbs. It is easily misdiagnosed as cerebral infarction).
Parkinson’s disease
Parkinson’s disease begins in adolescents and presents with various forms of dystonia, abnormal gait, and morning lightness and evening heaviness. Small doses of dopamine have dramatic effects.
Dopamine-responsive dystonia
It is a movement disorder with extrapyramidal impairment, manifested by postural dystonia, myotonia, chorea and tardive dyskinesia, with corticospinal tract involvement, psychosis and dementia. The disease progresses slowly. The MRI shows the “eye of the tiger” sign.
Histoplasmosis (HSD)
The clinical picture is similar to that of HSD, usually with stiffness of one limb, tonicity and hypokinesia, and then progressing to bilateral, without psychiatric symptoms, cerebellar signs, random movement and reflex abnormalities.
Striatal nigrostriatal degeneration
Progressive exacerbation of myoclonus, epilepsy and hypo-intelligence in youth. Pathological sections of the brainstem show basophilic inclusion bodies, and skin and muscle biopsies show Lafora vesicles.
Lafora’s disease has a slow onset in old age, with progressive exacerbation. Initially, it presents with unstable gait and falls, and later with supranuclear ophthalmoplegia, pseudoplegia, axial dystonia (slow movement, difficulty in turning) and mild dementia. In some patients, MRI shows significant atrophy of the midbrain.
Progressive supranuclear palsy (PSP)
It is more frequent in young adults and progresses slowly and fluctuatingly. Myotonicity is fluctuating (induced by random movements, tension, stimulation) and medial (pelvic girdle, scapular girdle, lumbar muscle involvement is common). Electromyography shows continuous motor unit activity at rest, with increased EMG emission during seizures. GADA autoimmune antibodies can be detected in the blood. MRI is mostly normal.
Stiff person syndrome
Slow onset, progressive choreiform movements, psychiatric abnormalities, dementia, genetic history. MRI shows atrophy of the cerebral cortex and caudate nucleus.
Huntington’s disease (HD)
Slow onset, progressive symmetric ataxia with cerebral, spinal, autonomic, and hypothalamic involvement, as well as muscle, cardiac, endocrine, and oculocutaneous involvement. Genetic history. MRI shows atrophy of the involved nerves. Genetic diagnosis is confirmed.
Hereditary ataxia
Adolescent onset, characterized by motor myoclonus, cerebellar ataxia (unsteady standing, staggering gait, poor distance discrimination, inability to coordinate, abnormal rapid alternating movements, poetic speech, gross nystagmus, reduced muscle tone). May be associated with seizures. Genetic history.
Myoclonic cerebellar coordination failure
Subacute onset, early signs and symptoms typical of diffuse cerebellar damage, often in conjunction with malignancy, late MRI shows cerebellar atrophy or abnormal signal changes.
Subacute cerebellar degeneration
The frontal, parietal and occipital lobes of the brain are connected to the cerebellar hemispheres by the frontal bridge bundle and the temporo-occipital bridge bundle, so ataxia can occur when the brain is damaged, but the symptoms are milder and nystagmus is rare.
Cerebral ataxia
Ataxia with damage to the posterior roots and cords of the spinal cord is not obvious when the eyes are open, but is obvious when the eyes are closed.
Deep sensory disorder ataxia
When standing or walking, the body tilts to the side of the disease and sways unsteadily, which is more obvious when walking in a straight line. It is often accompanied by vertigo, vomiting, and nystagmus. Abnormal vestibular function tests.