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A 86-year-old lady presented with sudden onset of appendicular ataxia of the right
arm with minimal weakness and no deep sensory loss. On neurological exam, she had
minimal pronator drift. She had undershooting and overshooting on attempting to reach
the target finger on finger to nose test. She also has dysdiadokokinesia and uncontrolled
rebound. The tests were not worsened with eyes closed. The sensory exam was unremarkable
including normal proprioception. Her brain MRI showed an area of acute infarct in
left posterior parietal lobe (Fig. 1) and no other lesion. Although parietal ataxia is generally considered to result
from loss of proprioceptive feedback inputs to the motor function [
], but our patient showed clinical features of classic cerebellar kinetic ataxia without
loss of proprioception. Brain MRI showed involvement of superior and part of inferior
parietal lobules with preserving paracentral lobule which is presumably responsible
for sensory innervation of contralateral limbs.
Fig. 1Brain MRI diffusion weighted image shows diffusion restriction in the left posterior
parietal lobe consistent with acute to subacute infarct.
An anatomical investigation of the corticopontaine projection in the primate (Macaca fascicularis and Saimiri sciureus)—II. The projection from frontal and parental association areas.
