Fig. 1
From: Recognition and management of rapid-onset gluten ataxias: case series
Magnetic resonance spectroscopy (MRS) of case 2 pre-treatment (A) and after 1 year of immunotherapy and gluten free diet (B). Pre-treatment there is disproportionate vermian spectroscopic abnormalities of the N-acetyl aspartate/Creatine ratio (NAA/Cr) from the vermis (0.63, normal > 1) in the presence of only mild atrophy. MR spectroscopy is a sensitive marker of cerebellar dysfunction prior to the development of atrophy and correlates with clinical severity. Following treatment, there has been significant improvement in vermian spectroscopic abnormalities with NAA/Cr ratio 0.80 in parallel with clinical improvement. MR spectroscopy is a sensitive marker for monitoring disease progression and treatment response which is not possible with just volumetric imaging. The patient has made almost a full recovery with just very minor tandem walking difficulties