The wide gait — cerebellar ataxia
| Patient | 55M, subacute phase |
|---|---|
| LesionRight cerebellar infarct (PICA territory) | |
| Severity | NIHSS 4 |
| Days since onset | 8 |
| Before the strokeIndependent. Warehouse supervisor, recreational cyclist. | |
| Also on the chart | None significant |
| PrecautionsVertigo on rapid head turns; Fall risk | |
Test yourself
What do you check first?
The teaching
Cerebellar cases invert the usual instinct: the limbs are strong and the gait is terrible, and the gap between those two facts is the whole case. Grade the ataxia (SARA), train coordination intensively — trunk first, precision graded — and explain the paradox to the family before they invent a weakness that is not there.
- The veer to the right follows the side of the lesion — document direction as well as distance; a changing veer is a clinical sign.
- Intention tremor worsens near the target — grade the precision demands of tasks, not just distance and speed.
- Rapid head turns provoke vertigo — sequence the environment so scanning demands build gradually rather than arriving all at once.
Read next
The full sequence
This page carries the case’s first decision. The full sequence — every decision, the five-domain examination, and the debrief that grades you — is in the drill, and the library is included with membership.
Sources on this page: Schmitz-Hübsch T et al. Scale for the assessment and rating of ataxia: development of a new clinical scale. Neurology. 2006;66(11):1717–1720. · Schmitz-Hübsch T et al. Neurology. 2006;66(11):1717–1720. · Ilg W et al. Intensive coordinative training improves motor performance in degenerative cerebellar disease. Neurology. 2009;73(22):1823–1830. Winstein CJ et al. Stroke. 2016;47(6):e98–e169. · Ilg W et al. Neurology. 2009;73(22):1823–1830. Winstein CJ et al. Stroke. 2016.