Differential Diagnosis for Cerebellar Ataxia and Associated Symptoms

The patient presents with cerebellar ataxia, dizziness, nystagmus, dysmetria, and a positive Romberg test. These symptoms suggest a problem with the cerebellum or its connections. Here is a differential diagnosis organized into categories:

• Single Most Likely Diagnosis
  • Vestibular Neuritis or Labyrinthitis: These conditions often present with sudden onset of vertigo, nystagmus, and ataxia due to inflammation of the vestibular nerve or inner ear. The symptoms can include dizziness with head movements and difficulty with balance, aligning with the patient's presentation.
• Other Likely Diagnoses
  • Benign Paroxysmal Positional Vertigo (BPPV): Characterized by brief but intense episodes of vertigo triggered by specific head movements, BPPV could explain the dizziness and nystagmus, especially if symptoms are exacerbated by positional changes.
  • Cerebellar Stroke or Infarct: A stroke affecting the cerebellum can cause ataxia, dysmetria, and nystagmus. While less common than other stroke locations, cerebellar strokes are a critical consideration due to potential for brainstem compression and hydrocephalus.
  • Multiple Sclerosis (MS): MS can present with a wide range of neurological symptoms, including ataxia, nystagmus, and vertigo, due to demyelinating lesions in the central nervous system, including the cerebellum and brainstem.
• Do Not Miss Diagnoses
  • Posterior Circulation Stroke: This includes strokes affecting the brainstem, cerebellum, or posterior cerebral arteries. It's crucial to identify and treat promptly due to the risk of rapid deterioration and high morbidity.
  • Brainstem Tumor: Tumors in the brainstem can cause a variety of symptoms depending on their location, including ataxia, nystagmus, and vertigo, by compressing or infiltrating critical structures.
  • Wernicke's Encephalopathy: This is a medical emergency caused by thiamine deficiency, often seen in alcoholics, characterized by ataxia, ophthalmoplegia, and confusion. Prompt treatment with thiamine can prevent long-term damage.
• Rare Diagnoses
  • Spinocerebellar Ataxia (SCA): A group of autosomal dominant genetic disorders that cause progressive cerebellar ataxia. While rare, they should be considered in patients with a family history of ataxia or those with progressive symptoms.
  • Acute Cerebellitis: Inflammation of the cerebellum, which can be caused by viral infections or autoimmune processes, leading to ataxia, dysarthria, and nystagmus. It's a rare condition but can have significant morbidity if not recognized and treated appropriately.

Each of these diagnoses has the potential to explain the patient's symptoms to varying degrees. A thorough history, physical examination, and diagnostic testing (such as MRI of the brain) are essential to narrow down the differential diagnosis and guide appropriate management.