Neurogenic urinary retention in SCA31 can be listed in the clinical

differential Nutlin-3 concentration diagnosis of cerebellar ataxia. However, possible outflow obstruction in men should always be explored. Clinical differential diagnosis of degenerative cerebellar ataxia is still a challenge for neurologists. Most cases are sporadic, and the cerebellar form of multiple system atrophy (MSA-C) is the most common in Asian countries.[1] MSA-C appears as a combination of cerebellar ataxia and prominent autonomic dysfunction including syncope, urinary retention and sleep apnea.[1] Autosomal-dominant cerebellar ataxias (ADCA) are rare causes of cerebellar ataxia. The most common genetically determined ADCAs worldwide are spinocerebellar ataxia type 3 (SCA3, also called Machado-Joseph disease) and SCA6. As compared with MSA-C, autonomic dysfunction BGJ398 research buy is not common in SCA3 and SCA6, whereas moderate urinary dysfunction does occur in both forms.[2, 3] In Japan, where it was initially described, SCA31 represents the third most common ADCA;[4] it is also known to occur in Caucasians.[5] SCA31 is caused by large insertions of pentanucleotide repeats ((TGGAA)n) into the genes coding for thymidine kinase

2 (TK2) and BEAN, or brain-expressed protein associated with NEDD4 (neural precursor cell-expressed developmentally down-regulated protein 4).[4] Clinically, SCA31 presents with a relatively pure cerebellar phenotype, including ataxia,

dysarthria, oculomotor impairments and variable hearing loss. Onset is usually in late adulthood. Brain magnetic resonance imaging (MRI) shows cerebellar atrophy.[4, 6] Post-mortem studies of SCA31 reveal atrophy and loss of cerebellar Purkinje cells, surrounded by amorphous materials that are positive for synaptophysin, ubiquitin and calbindin.[4, 6] Autonomic dysfunction has not been well known and no urodynamic data are available in SCA31. Recently, we had a case of a man with SCA31 who, after a 5-year history of cerebellar ataxia and positional dizziness, Methocarbamol developed partial urinary retention. A 73-year-old man with a 5-year history of staggering gait, dysarthria and positional dizziness developed mild urinary frequency and voiding difficulty. His father and a sister also had cerebellar ataxia. His father was born in Nagano prefecture, which is a common site of SCA31 in Japan. His sister was diagnosed with SCA31 through the detection of large insertions of TGGAA pentanucleotide repeats. He was admitted to the emergency department of our hospital because of fever and dehydration due to bronchopneumonia. On referral to our neurology department, he displayed cerebellar ataxia in eye movement, speech, limbs and gait. Visual suppression of caloric nystagmus was reduced, which indicated dysfunction in the vestibulocerebellum.[7] He had sensorineural hearing loss for high tones. His swallowing function was normal.