Hallmarks of HACE are encephalopathic symptoms and signs, including ataxic gait
severe lassitude, and progressive decline of mental function and consciousness (irritability, confusion, impaired mentation, drowsiness, stupor, and finally coma).
The patient's ataxic gait
is proposed to have similar origins, as described in previous reports of patients with polyneuritic leprosy, absent tendon reflexes in the ataxic limbs and no other cause for ataxia.
In the control examination performed in the second month after the treatment program, it was observed that the patient could walk long distance with a double tripod, ataxic gait
was almost completely improved, and his speech was more fluent and rapid.
On examination she had intention tremor, horizontal nystagmus, ataxic gait
and left hemiperesis.
As they age, patients have pes planus (flat feet) and a stooped ataxic gait
Because of the neurological alterations in association with ataxic gait
and low levels of vitamin B12, nuclear magnetic resonance of the cervical and thoracic spine was requested, which documented images compatible with sub-acute combined degeneration of the spine (Figure 2).
Physical examination was remarkable for a hoarse voice, ocular motility characterized by saccadic intrusions and impaired vertical gaze upwards, a mildly ataxic gait
, and diminished sensation in his distal lower extremities.