Case report

A 44-year-old man presented with a 1-year history of progressively poor balance and recurrent falls. On examination, he had a cerebellar syndrome with nystagmus, dysarthria, truncal and limb ataxia, dysmetria, and bilateral intention tremor. Limb strength and sensory examination were normal, with no pyramidal or extrapyramidal signs. His cognitive functions were normal (Montreal Cognitive Assessment score was 30). He had no psychiatric features such as stereotypy or punding, and no choreoathetosis or involuntary movements.

MR scan of the brain showed multiple diffuse and scattered T2/fluid-attentuated inversion recovery (FLAIR) hyperintense lesions involving the periventricular, subcortical and deep white matter bilaterally along the frontal, parietal, temporal, occipital lobes, brainstem as well as both cerebellar hemispheres (figure …