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Morning Report. Acute Ataxia 8/31/09 Lorena Muñiz, MD. Definitions. Ataxia: From Greek ataktos : without order. Failure of muscular coordination. Pathologic abnormality of organization or modulation of movement.

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Morning report

Morning Report

Acute Ataxia

8/31/09

Lorena Muñiz, MD


Definitions
Definitions

  • Ataxia: From Greek ataktos: without order.

    Failure of muscular coordination.

    Pathologic abnormality of organization or modulation of movement.

    Disturbances in the control of body posture, motor coordination, speech control and eye movements.


  • Dizziness:impairment in spatial perception and stability, considered imprecise.

  • Vertigo: sensation of spinning or having one's surroundings spin about them.


  • Dysmetria: From English difficult to measure.

    Lack of coordination of movement typified by the undershoot and/or overshoot of intended position with the hand, arm, leg, or eye.



  • Dysarthria:

    Motor speech disorder resulting from neurological injury, characterised by poor articulation

  • Nystagmus: form of involuntary eye movement characterized by alternating smooth pursuit in one direction and rapid movement in the other direction.


  • Opsoclonus:

    Rapid, involuntary, multivectorial (horizontal and vertical), unpredictable, conjugate fast eye movements.

  • Myoclonus:

    Brief, involuntary twitching of a muscle or a group of muscles.


  • Romberg's test:assess the dorsal columns of the spinal cord.Indication of loss of the sense of position, patient loses balance when standing erect, feet together, and eyes closed. +Romberg: ataxia is sensory in nature, depending on loss of proprioception.

    – Romberg: ataxia is cerebellar.


Types of ataxia
Types of Ataxia

  • Cerebellar ataxia

  • Vestibulocerebellum impaired balance and control of eye movements, postural instability.

  • Spinocerebellum wide-based "drunken sailor" gait.

    3. Cerebrocerebellum disturbances in carrying out voluntary, planned movements.


  • Sensory ataxia: Loss of proprioception (joint position sense), dysfunction of the dorsal columns of the spinal cord, spinal nerve roots or peripheral nerves.

  • Vestibular ataxia: Loss of balance, in acute and unilateral cases is associated with prominent vertigo, nausea and vomiting.


Etiology
Etiology

  • Infectious/immune-mediated cerebellar disorders

    • Acute cerebellar ataxia*

      • Post infectious cerebellitis

    • Acute demyelinating encephalomyelitis

    • Systemic infections

    • Brainstem encephalitis

    • Multiple sclerosis


  • Toxic

    • Alcohol

    • Anticonvulsants (phenytoin, carbamazepine)

    • Benzodiazepines

    • Barbiturates

    • Antihistamines

    • Lithium

    • Heavy metals (lead, mercury, thallium)


  • Mass lesions

    • Tumors: brain stem, cerebellum

    • Vascular lesions (AVM)

    • Abscesses

  • Hydrocephalus

  • Trauma

    • Head

    • Neck (vertebral artery dissection)


  • Vascular events

    • Stroke, hemorrhage

  • Paraneoplastic disorders

    • Opsoclonus-myoclonus syndrome: Occult Neuroblastoma or ganglioneuroblastoma

  • Sensory ataxia

    • Miller Fisher syndrome: ataxia, areflexia, ophtalmoplegia(vertical gaze)


  • Paretic ataxia

  • Other neurologic disorders

    • Basilar migraine: vertigo, hemiparesis, cranial nerve dysfunction, N/V/HA

    • Benign paroxysmal vertigo

    • Seizures

    • Inborn error of metabolism

  • Functional


Work up
Work up

  • History:

    • Prior or current symptoms of infection.

    • Recent immunizations.

    • Headaches, vomit, diplopia.

    • ROS.

    • Drug ingestion.

    • Head on neck trauma.

    • Similar episodes in past or in family.


  • Physical exam

    • Complete neurological exam

      • Mental status

      • Cranial nerves

      • Cerebellar testing

      • Sensation

      • Strength

      • Meningeal signs

      • Reflexes

      • Gait




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