!"#$%#$&'(#%)'7'B)*+,(,&#-.

!"#$%#$&'(#%)'$)*+,(,&#-.
G")+)'H-'.")'
/-'#.'0#1)+)$2)3
()-#,$3
G"7.I-'.")'
4+5'6*+7.'!7$8+797.):';4:'<=>?@!A
B,+.")+$'B)*+,-2#)$2)'>)$.)+
()-#,$3
>"#7$&C7#'D$#E)+-#.F

H$1#$0&(%&0.$*0&.(&'(++$'.&D,., >,C8()J'K+7#$'8+,2)--#$&
6,08& 9(,+&
!"#$%&'()*+,#-.
6#**#-7&."$&*(#-.

/#0.(12&

!()*+,#-.&$C*+(1$1
B$?1(+(7#',+
$C,)#-,4(- !(-31),4(-
(%&+(',+#5,4(-

@#0.&(%&."$&
*1(A+$)0 :$;#$<&(%
=,4$-.>0*$'#3'&%$,.?1$
:,-8&(%&(1D$1&(%
@#8$+#"((D&(%&*(00#A+$&D#0$,0$ E#F$1$-4,+&D#,7-(0#0

>,C8,$)$.',L'>"#)L'>,C8(7#$.
H2)*.()I0J&(1&H2-D1()$
K

>"#)L'2,C8(7#$. 6#)$&'(?10$I*1(71$00#;$L&0.,A+$L&M?'.?,4(-J
N-0$.I0?DD$-L&,'?.$L&0?A,'?.$L&'"1(-#'J

M!#88#$&'.")'8,#$.N

!(++$'.&."$&
PC*,-D&."$&#D$,
G 1#7".&D,., O
!")'8,#$.'-",*(0'K)'2,$2)+$)0 !())(-&)#0#-.$1*1$.&02)*.()0&
• =,+,+20#0&SH& • U+?1&;#0#(-&SH&
• Q;(#D&(;$1&7$-$1,+#5,4(- -?)A-$00 E#*+(*#,
• Q;(#D&)#0#-.$1*1$.&02)*.()0 • E#55#-$00&SH& • U+,'8(?.V&+(00&(%&
<$,8-$00&SH&T,47?$& '(-0'#(?0-$00&SH&+(00&
• Q;(#D&#-'()*+$.$&'"#$%&'()*+,#-.
SH&,.,C#, (%&;#0#(-&SH&0#)*+$&
• Q;(#D&0.$*&.(&."$&*1$0$-.&#++-$00& • E20*",0#,&SH& '(-%?0#(-
A$%(1$&",;#-7&,-&#D$,&M(<&'",1. D20,1."1#,

OJ87$0'.")'#0)7 H2)*.()0&,**1(,'">X&
M6FC8.,C7.,(,&F'
788+,72"N • 4#-,+0)+',L'2,$-2#,*-$)--
Z-&2(?1&"$,D – @$;$+&(%&'(-0'#(?0-$00
– !(-.$-.&(%&'(-0'#(?0-$00
• ;)$.7('0#-,+0)+
– Y$)(12
– Z-.$++#7$-'$
– =$10(-,+#.2
– U$",;#(1,+&
– E$)$-4,&
• P#&")+'2,+Q27('L*$2Q,$'
0#-,+0)+
– Q*1,C#,L&,*",0#,L&,7-(0#,L&
(."$10
• R#-*7('0#-,+0)+
– S#0?,+&+(00
W – E#*+(*#,

H2)*.()0&,**1(,'">[ H2)*.()0&,**1(,'">]&

• S7$&*7&)'7$0'-8))2"' Z-&2(?1&"$,D
0#-,+0)+ Z-&2(?1&"$,D • 6)$-,+F'0#-,+0)+
– E20,1."1#, – =,#-&D#0(1D$1
– E20*",0#,& • /$,D,'"$&,-D&%,'#,+&*,#-
• S,9)+'2+7$#7('$)+E)' • N."$10&*,#-&D#0(1D$1
0#-,+0)+ – B?)A-$00\4-7+#-7
– E$,%-$00\4--#.?0 • ;,.,+'0#-,+0)+'
– S$147(
– ^$,8-$00V&$,'"&*,1.
– U,+,-'$\0.,77$1#-7
– H<,++(<#-7
– Y(;$)$-.&D#0(1D$1
– S(#'$&'",-7$ • 68"#$2.)+'0#-,+0)+
 H2)*.()0&,**1(,'">_ 6F$0+,C)'788+,72"UV
• O8#-,0#2'0#-,+0)+ Z-&2(?1&"$,D • ?7+%#$-,$#-C • ;*(Q8()'2+7$#7('$)+E)'
– H$#5?1$\$*#+$*02 – U1,D28#-$0#, -F$0+,C)
– H2-'(*$ – Y?0'+$&1#7#D#.2 `02-D1()$&(%&
– 6ZQ – :$04-7&.1$)(1 (*.",+)(*+$7#,a
– QA-(1),+&)(;$)$-. – =(0.?1,+&#-0.,A#+#.2 `02-D1()$&(%&@(<$1&
– Y#71,#-$& !B&#-;(+;$)$-.a
• T+7#$'-.)C'-F$0+,C)
`H?DD$-&(-0$.&*+?0&
A1,#-&0.$)&0\0a
X_

6F$0+,C)'788+,72"UW
• 68#$7('2,+0' • >)+)2)((7+'-F$0+,C)
-F$0+,C)

OJ7C8()
> =,-'$1$A$++,1&
– 61,-0;$10$&'(1D& 02-D1()$
02-D1()$I'()*+$.$L& > /$)#'$1$A$++,1&
#-'()*+$.$J
02-D1()$
– /$)#'(1D&02-D1()$
> !$1$A$++,1&;$1)#0&
– Q-.$1#(1&'(1D&
02-D1()$
02-D1()$
– =(0.$1#(1&'(1D&
02-D1()$
XG XO

6FC8.,C7.,(,&F

E#c'?+.&.(&(*$-&
"#0&$2$

?7Q)$.'P#-.,+F
XR Xb
 6FC8.,C7.,(,&F 6FC8.,C7.,(,&FX'OF)(#0'0#-,+0)+
• @#D&,A-(1),+#4$0&*1$0$-.0&,0
–=.(0#0
E(?A+$&;#0#(- –@#D&1$.1,'4(-
`E#*+(*#,a –Z-0?c'#$-.&$2$+#D&'+(0?1$
–PC'$00#;$&$2$+#D&'+(0?1$

XW [d

OJ2)--#E)'
?.,-#- )F)(#0'2(,-*+)
^$,8-$00&(%&
@$;,.(1&*,+*$A1,$&
!(-.1,'4(-&(%&
(A#'?+,1#0&('?+#& ?.,-#-'
)?0'+$ )?0'+$

Y?++$1&)?0'+$V fU+$*",+(0*,0)
788+,72"
/(1-$1e0&02-D1()$ f/$)#%,'#,+&0*,0)
[X [[

=.(0#0&&
B(->-$?1(7$-#'I)$'",-#',+J&
*.(0#0
B$?1(+(7#'&&*.(0#0
!(-7$-#.,+&*.(0#0

•g-#>A#+,.$1,+ •=?*#+&#-;(+;$)$-.
•=,14,+>'()*+$.$ •PNY&#)*,#1)$-.

@YB /(1-$1e0&
H?*1,-?'+$,1& •B$?1(*,."#'IBL&
+$0#(-I'$1$A1,+&*.(0#0J %,0'#'+$L&!BJ 02-D1()$

4+*&'#$0*2)0'K()8"7(,-87-C'7$0'
•!(-.1,+,.$1,+& •BYh
'$1$A1,+&"$)#0*"$1$ •Y2(*,."#'&

0F-%#$)-#7 [_
Superior tarsal muscle
(also known as
Müller's muscle)

[G [O

4#8(,8#7
788+,72"
Y'9,C7$'8+)-)$.'9#."'
0,*K()'E#-#,$ [R [b

E#*+(*#, Y(-('?+,1&D#*+(*#,V&
• Supranuclear(UMN)
• FEF: horizontal conjugate
Y(0.+2&(*.",+)(+(7#'& gaze
'(-D#4(- • Diffuse frontal and
U#-('?+,1&D#*+(*#, occipital: vertical
conjugate gaze
B(->)#0,+#7-)$-.V • Internuclear
#-.$1)#i$-.L&-(-> • Nuclear and pathway
(17,-#' • PPRF, abducen
interneuron, MLF
Y#0,+#7-)$-. • riMLF, INC, PC
• Nuclear(LMN)
• Cranial nerve nuclei
>,C#.7$.' /$2,C#.7$.' • Fascicle, Nerve,
-.+7K#-C*- -.+7K#-C*- NMJ and
Muscle(LMN)
!"#+D"((D& • Faciculus
0.1,A#0)?0
Y(0.+2&B$?1(>
• Cranial nerve
(*.",+)(+(7#'&
• NMJ
D#0$,0$ • Muscle
 4#8(,8#7X'!"#$%#$&'/0)7
• E#1$'4(-&(%&#-;(+;$D&)?0'+$
– Z)*,#1&'(-0#0.$-.&<#."&-$1;$&#--$1;,4(-IB$1;$L&
-?'+$?0J
– #%&-(.
• T+?'.?,4(-V&BYh
• Q00('#,.$D&<#."&*1(C#),+&)?0'+$&<$,8-$00V&Y?0'+$&
D#0$,0$
• S$14',+&7,5$&(1&/(1#5(-.,+&7,5$&*,."<,2&#-;(+;$)$-.V&
Z-.$1-?'+$,1&+$0#(-

OF)')J7C#$7Q,$
]X ][

Y'9,C7$'2,C8(7#$-'-(,9'8+,&+)--#E)'
0#8(,8#7:'&7#.'0#Z2*(.F'L,+'W'9))%-
T#(7.)+7('8,$Q$)'#$L7+2Q,$ ]] ]_

• Supranuclear(UMN)
• FEF: horizontal conjugate
gaze
• Diffuse frontal and
occipital: vertical
conjugate gaze
• Internuclear
• Nuclear and pathway
• PPRF, abducen
interneuron, MLF
• riMLF, INC, PC
• Nuclear(LMN)
• Cranial nerve nuclei
• Fascicle, Nerve,
NMJ and
Muscle(LMN)
• Faciculus
• Cranial nerve
OF)'C,E)C)$. •
•
NMJ
Muscle
]G
 ]b

[7#.'
7K$,+C7(#.F
[7#.'
0#-.*+K7$2) j Y.7J#7

]W _d

!7$0)C'97(% >)+)K)((7+'.)-.
_X _[
 Q**1(,'"&.(&,.,C#'&*,4$-. ^"$1$e0&+$0#(-k
Ataxic symptoms?
-Nystagmus
-Dysarthria Q00('#,.$D&0#7-
-Trunkcal ataxia
-Limb and gait -ataxia
Ataxic symptoms
mimicker?
Pure cerebellum With With mild hemiparesis
•Y#+D&<$,8-$00 True Ataxia Brainstem
•Q*1,C#, Ataxia: disease signs
•QA-(1),+&)(;$)$-. other than cerebellum
Classified
Cerebellar Involve fronto-
Cerebellar’s disease syndrome Classified Ponto-
-Where’s the lesion (cerebellum, Brainstem Cerebellar
cerebellar peduncle, cerebellar Syndrome? Pathway
tract) “Ataxic hemiparesis”
-What’s the lesion

!+,00#3$D&'$1$A$++,1&02-D1()$
H2))$.1#',+&,.,C#,&*+?0&02-D1()$

Cerebellar Unilateral
• Q'l?#1$D&
hemispheric intermediate,
syndrome lateral zones – ^$1-#'8$e0&$-'$*",+(*,."2
– Y#++$1&T#0"$1&02-D1()$
Rostral
vermis
Ant,
sup vermis
– B(1),+&*1$00?1$&"2D1('$*",+?0I%1(-.,+&+(A$&
syndrome
,.,C#,J
Caudal Flucculo • /$1$D#.,12&
vermis nodular,
syndrome post vermis – H*#-('$1$A$++,1&,.,C#,IH!QJ

Pan All
cerebellar regions
syndrome

T72%'.,',*+'27-)
B*2()7+'2,C8()J'
,L',2*(,C,.,+'
$)+E)

=,-.+7('E)+C#-'
-F$0+,C)
_R _b
 B)*+,(,&#27(')J7C#$7Q,$
?"F-#27(' • 62+))$#$&@&)$)+7(A'$)*+,(,&#27('

OJ7C#$7Q,$
)J7C#$7Q,$
– PC,)&$;$12&*,."V&."$&.$0.0&,1$&)(1$&0$-0#4;$
• 68)2#\2@L,2*-)0A'$)*+,(,&#27(')J7C#$7Q,$
– PC,)&."$&D$.,#+&(%&,A-(1),+&-$?1(+(7#',+&0#7-0&
M>,$\+C'.")'.",*&":' (1&02)*.()0&1$+$;,-.&.(&."$&"#0.(12&,-D&
0'1$$-#-7&$C,)m
)J8(,+)'.")'$)J.N – ."$&.$0.0&,1$&)(1$&0*$'#3'

_W Gd

=)2,+0'.")'$)*+,(,&#27('-#&$- 9$-$1,+&-$?1(+(7#',+&$C,)#-,4(-
• Y$-.,+&0.,.?0 • 9,#.&,-D&A,+,-'$
• =1$0$-'$&SH&QA0$-'$ • !1,-#,+&-$1;$& • :()A$17&.$0.
– X>X[&!B&%?-'4(-
• /,1D&0#7-0&SH&H(n&0#7-0 • @#)A&
• B(1),+&SH&,A-(1),+ – S(+?-.,12&)(;$)$-.
– Y?0'+$V&A?+8L&.(-$L&*(<$1&
• @,.$1,+#5#-7&0#7-V& – !((1D#-,4(-V&T6BL&/6HL&1,*#D&
,+.$1-,4-7&)(;$)$-.
• 61?$&SH&%,+0$&+(',+#5#-7&0#7- – :$M$CV&.$-D(-L&*+,-.,1&
1$0*(-0$
• B(1),+&;,1#,4(- – H$-0,4(-V&*#-*1#'8L&h=HL&
;#A1,4(-&0$-0$

GX

!")'8,#$.'-",*(0'K)'2,$2)+$)0

• Q;(#D&)#0#-.$1*1$.&0#7-
• Y#0#-.$1*1$.&."$&-(1),+&;,1#,4(-
• !(-31)&."$&$l?#;(',+&0#7-&
• Q<,1$&."$&0(n&0#7-
• Q<,1$&."$&%,+0$&+(',+#5#-7&0#7-
Y'C7$'8+)-)$.)0'9#."'
G] -"7%#$&'")70 G_
 <,2*-)0'$)*+,(,&#27(')J7C#$7Q,$
• ^"#'"&8#-D&(%&.$0.
– E$*$-D&(-V&/#0.(12L&H'1$$-#-7&-$?1(+(7#',+&
$C,)#-,4(-
– !()*+$.$&."$&%('?0$D&$C,)#-,4(-V&
• Y(1$&D$.,#+
• !()*+$.$&."$&02-D1()$&2(?&."(?7".
• B$$D&$C.$-0#;$&08#++&%(1&0*$'#3',4(-

Y$',(0'9,C7$'8+)-)$.'9#."'
7K$,+C7('"7$0'C,E)C)$. GG GO

!(-'$*.&(%&`0(na&-$?1(+(7#',+&0#7-
• `/,1D&0#7-aV&
– -$?1(+(7#',+&0#7-&1$0?+.&%1()&,&+$0#(-&,.&,&8-(<-&
0#.$&(1&.",.&,F$'.&,&8-(<-&*,."<,2
• `H(n&0#7-aV&
– Q-2&0.1?'.?1,+&(1&%?-'4(-,+&D$;#,4(-&%(?-D&)(1$&
%1$l?$-.+2&#-&A1,#-&#)*,#1)$-.&*$10(-0&.",-&#-&
-(1),+&*$10(-0
– E($0&-(.&'(11$+,.$&<#."&,-2&*,14'?+,1&.2*$&(%&A1,#-&
+$0#(-&,.&,-2&*,14'?+,1&0#.$L&(1&#-.$11?*4(-&(%&,-2&
*,14'?+,1&.1,'.
!(-'$*.&(%&`%,+0$a&+(',+#5#-7&0#7-
• 61?$&0#7-&.",.&(''?10&0$'(-D,12&.(&,&+$0#(-&
$+0$<"$1$&#-&."$&!BHm&
• 6"$&0#7-&#0&-(.&%,+0$L&A?.&#0&D#0.,-.&%1()&."$&
,'.?,+&0#.$&(%&*1#),12&+$0#(-
• !,?0$V
– H"#n&(%&A1,#-V&'()*1$00&(1&D#0*+,'$&0.1?'.?1$&
ID#0.,-.J&(1&A+((D&;$00$+&IQ!QL&Y!QJ
– /2D1('$*",+?0V&!B&O&*,+02L&=1$.$'.,+&I02+;#,-J&
02-D1()$

?+,K()C'(#-.
M=)E#)9',L'87Q)$.'
-8)2#\2'L)7.*+)N
GW Od
 @#0.&(%&*1(A+$)0
Z-.$71,.$&(%&/#0.(12&,-D&=P 4#1)+)$Q7('0#7&$,-#-
• T#10.V&,-,.()#',+&+(',+#5,4(-&(%&+$0#(-&(1& E#0'?00#(-&$,'"&*1(A+$)&+#0.
-$?1(+(72&020.$) • XJ
– T(',+L&Y?+4>%(',+L&E#F?0$ • [J
– B?'+$,1L&.1,'.L&020.$)&D#0(1D$1 • ]J
– !BHL&=BHL&U(."0 • _J
• GJ

4#1)+)$Q7('0#7&$,-#-
/$.)&+7.)',L'P#-.,+F'7$0'?O
4#1)+)$Q7(' • <#+-.X'7$7.,C#27('(,27(#]7Q,$' • 6)2,$0X'27*-)',L'()-#,$
,L'()-#,$',+'$)*+,(,&F' – !(-7$-#.,+L&9$-$4'

0#7&$,-#-
-F-.)C – 61,?),
– T(',+L&Y?+4>%(',+L&E#F?0$ – 6?)(1
– B?'+$,1L&.1,'.L&020.$)&D#0(1D$1 – Z-%$'.\Z-M,)),4(-
– !BHL&=BHL&U(."0 – S,0'?+,1
– 6(C#'\)$.,A(+#'\B?.1#4(-,+
– E$7$-$1,4(-\E$)2$+#-,4(-
M=7$%',L'.")'8,--#K()' –
–
ZD#(*,."#'
=02'"(7$-#'&

0#-)7-)N
O]

H$1#$0&(%&0.$*0&.(&'(++$'.&D,.,
6,08& 9(,+&
!"#$%&'()*+,#-.
6#**#-7&."$&*(#-.

/#0.(12&

!()*+,#-.&$C*+(1$1
B$?1(+(7#',+
$C,)#-,4(- !(-31),4(-
(%&+(',+#5,4(-

@#0.&(%&."$&
*1(A+$)0 :$;#$<&(%
=,4$-.>0*$'#3'&%$,.?1$
:,-8&(%&(1D$1&(%
@#8$+#"((D&(%&*(00#A+$&D#0$,0$ E#F$1$-4,+&D#,7-(0#0
 Thank you
for your
attention.
www.neurologycoffeecup.com
Combine it together