Patient 1 presented with a 21-months history of progressive cerebellar and brainstem syndrome of unknown origin including trunk and limb ataxia, ataxic dysarthria, down-beat-nystagmus and double vision as well as mild spastic tetraparesis and left-sided hemihypaesthesia of the face and arm beginning at the age of 51 years. SARA score was 27/40 at 21 months after disease onset.
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