Central and peripheral vestibular signs simultaneously present in a patient with instability: A case report

Abstract

Introduction. Cerebellar ataxia, neuropathy, vestibular areflexia syndrome is a rare neurodegenerative disease with instability as the main presenting symptom. Patients with this syndrome often present with central and peripheral vestibular signs. This slowly progressive disease usually starts after 60 years of age and it takes 11 years to diagnose it. Case Report. Here I present a 62-year-old woman with instability lasting for 7 years, but deteriorating in the last two years with two episodes of falls, diplopia when looking to the right, paresthesia in the extremities and clumsiness with hands. Clinical examination revealed dysarthria, positive Romberg test, left hand dysmetria, gaze evoked and downbeat nystagmus, positive head impulse test, absent vestibulo-ocular reflex at video head impulse test, no response to caloric stimulation, no smooth pursuit and dysmetric and prolonged saccades at videonystagmography, positive visually enhanced vestibulo ocular reflex test, normal head magnetic resonance imaging, subclinical signs of polyneuropathy at electroneurography and negative autoimmune and paraneoplastic cerebellar antibodies. Conclusion. Instability is the first symptom in patients with cerebellar ataxia, neuropathy, vestibular areflexia syndrome. Easy to perform, positive visually enhanced vestibulo-ocular reflex test points to a concomitant central and peripheral vestibular disorder. Negative autoimmune and paraneoplastic antibodies rule out other cerebellar diseases. However, normal head magnetic resonance imaging findings without expressed signs of peripheral sensory neuropathy are in concordance with a slowly progressive form of this syndrome.

Medical terminology in new age Serbia: Over 150 years of existence

“…Radivoje Pavlovic, even as a very young physician, pointed to the potential dangers in creating proper medical terms: "Semi-literate intellectuals, in abundance in their professions, insufficiently study their own language during their studies, so they become resistant to the influences of grammar, syntax, and style of foreign languages, especially if they stay longer there. That`s the source of numerous mistakes of all kinds, not only in journalistic, popular, or professional literature but even in belletristic" 1 . And on he goes: "Basic knowledge of one`s own language should be the duty of every intelligent person and it should especially be requested from people who write or are in education".…”

“…It especially applies to environments in which these areas are new or were undeveloped until then, compared to others, as well as the inclusion of the local language into the socio-scientific level of development of the environment. As professor Radivoje Pavlovic, first assistant to Arnold Holst, the founder of the Pharmacology Institute of the Medical University in Belgrade, and the first Serbian professor of Pharmacology, writes in his article "On medical terminology" from 1928: "...development of our medical literature brought the creation of new phrases...for marking new terms we must create new phrases" (Figure 1) 1 . He emphasizes there must be some ground rules in creating medical terminology and " in main questions, there should be some directives, there should be some prop".…”