July 29, 2026

@michaelokun

One of my favorite teaching pearls from Tony Lang at the Aspen Movement Disorders Course this morning was deceptively simple: always pay attention to the tempo of an ataxia. The time course often provides the biggest clue to the diagnosis. An acute ataxia should make you think about stroke, toxins, metabolic disorders, or infection. A subacute presentation raises concern for autoimmune, paraneoplastic, or neoplastic causes. A chronic, slowly progressive syndrome points more toward degenerative, genetic, or other structural disorders. Before ordering a long list of tests, pause and ask one question: How fast did this develop? Sometimes the clock is the most powerful diagnostic tool we have.