[A case of XXXX showing severe @entity3519 masquerading as @entity2045 movements on arm extension].

@entity1 @entity614 @entity3520 @entity2045 @entity425 @entity194 @entity76 @entity6447 @entity3519 @entity717 @entity427 @entity121 @entity413 @entity2055
A 43-year-old @entity1 was admitted to our hospital due to unstable walking, head tilting to the left and difficulty in extending his arm. He was quite healthy until the age of 20 years, when these symptoms appeared and progressed slowly afterward. Due to his unstable walking, he started to use a wheelchair when he was 39 years old. He had no family history of similar disease. On admission, neurological examination revealed spasmodic torticollis, ataxic speech and marked limb and @entity2055 . @entity2045 flexion of the forearm was induced when he raised and extended his forearm. He also showed mild @entity427 in the lower limbs without pathological reflexes. He had @entity425 and @entity194 of the left supraspinatus, infraspinatus, @entity121 and mild superficial sensory impairment in the left axillary nerve territory due to cervical @entity614 of the left C5 root. MRI of the brain demonstrated severe bilateral @entity194 of the cerebellar hemispheres and vermis but minimal @entity194 of the cerebrum and brainstem. Because surface electromyography revealed continuous discharge with phasic components in the biceps and wrist flexor muscles on extending the upper limbs, the jerky flexion movement of the forearm was considered to be primarily @entity3519 . Although no giant SEP was observed, a C-response was detected in the long-loop reflex in response to right median nerve stimulation. Nuclear examinations showed diffuse hypoperfusion and decreased @entity413 metabolism in the cerebellum. Based on these findings, we hypothesized that @entity76 may have induced severe @entity3520 resembling @entity2045 . We would like to name this complicated involuntary movement an "arm thrust". This is the first case to be reported of sporadic, chronic, progressive @entity6447 accompanied by severe @entity3520 , especially on stretching the forearms, that mimics @entity717 .
