Cerebellar Atrophy Associated with Primary Sjögren's Syndrome: Diagnosis, Therapy, and Virtual Reality Rehabilitation: A Case Report

Emanuele Lo Voi; Giorgio Carmelo Basile; Alessia Bramanti; Giuseppe Paladina; Annalisa Militi; Daniele Bruschetta; Angelo Alito; Filippo Cavallaro; Salvatore Bertino; Demetrio Milardi

Cerebellar Atrophy Associated with Primary Sjögren's Syndrome: Diagnosis, Therapy, and Virtual Reality Rehabilitation: A Case Report

Innov Clin Neurosci. 2021 Jul-Sep;18(7-9):11-17.

Authors

Emanuele Lo Voi^{1

2

3}, Giorgio Carmelo Basile^{1

2

3}, Alessia Bramanti^{1

2

3}, Giuseppe Paladina^{1

2

3}, Annalisa Militi^{1

2

3}, Daniele Bruschetta^{1

2

3}, Angelo Alito^{1

2

3}, Filippo Cavallaro^{1

2

3}, Salvatore Bertino^{1

2

3}, Demetrio Milardi^{1

2

3}

Affiliations

¹ Drs. Lo Voi, Bramanti, and Paladina are with the IRCCS Centro Neurolesi Bonino Pulejo in Messina, Italy.
² Drs. Basile, Militi, Bertino, and Milardi are with the Department of Biomedical, Dental Sciences, and Morphological and Functional Images at the University of Messina, Messina, Italy.
³ Dr. Alito, Dr. Bruschetta, and Mr. Cavallaro are with U.O.C of Physical and Rehabilitation Medicine and Sports Medicine, Policlinico Universitario G. Martino in Messina, Italy.

PMID: 34980988
PMCID: PMC8667698

Abstract

Cerebellar involvement in primary Sjögren's syndrome (pSS) is an uncommon condition, with only a limited number of cases described worldwide. A 43-year-old woman affected by cerebellar atrophy associated with pSS was referred to our center to undergo a cycle of physical rehabilitation therapy. Although motor symptoms started when the patient was 23 years of age, the underlying disease remained undiagnosed for several years. Neurological examination before rehabilitation revealed ataxic gait, dysmetria, nystagmus, and hypermetric saccades; the patients complained about unsteadiness while standing or walking. To improve balance and gait abilities, a 20-session cycle of balance rehabilitation, based on a combination of conventional physical therapy and virtual reality exergames, was prescribed. The outcomes of rehabilitation were evaluated with balance tests and three-dimensional (3D) gait analysis. To our knowledge, this is the first case describing the diagnostic workout for cerebellar atrophy associated with pSS and the subsequent motor rehabilitation. This work highlights the importance of early diagnosis and rehabilitation in patients with central nervous system involvement in pSS.

Keywords: 3D gait analysis; Primary Sjögren’s syndrome; cerebellar ataxia; cerebellar rehabilitation; virtual reality rehabilitation.

Publication types

Case Reports