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A 40-year-old woman reported involuntary and irregular movements of her left toes accompanied by pain. This arose following arthroscopy after a sprained left ankle. She had involuntary flexion–extension and abduction and adduction movements of the hallux and the other toes, with reduced pinprick sensation on the skin web between the left hallux and the second toe. Nerve conduction studies confirmed a deep peroneal nerve axonal injury. We diagnosed the syndrome of painful legs and moving toes, provoked by a peripheral nerve injury. Her symptoms have persisted despite pregabalin, gabapentin and amitriptyline.

A 40-year-old man presented with a 10-year history of excessive sweating on the right side, progressing to absence of sweat, rough skin, heat intolerance, and blurred vision. Examination showed anhidrosis (right side), diffuse areflexia, and Adie tonic pupils. Starch iodine test showed absence of sweating (figure). Pupillary reflex was poor (video 1). Skin biopsy was unremarkable. Ross syndrome was diagnosed.

Cerebellar ataxias may have genetic and nongenetic causes. Early-onset and progressive ataxias are frequently related to an autosomal recessive inheritance. However, some nongenetic ataxias may occur in childhood or young adulthood.1,2