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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.

slide3
Dizziness:impairment in spatial perception and stability, considered imprecise.
  • Vertigo: sensation of spinning or having one\'s surroundings spin about them.
slide4
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.

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Dysdiadochokinesia: From Greek dys "bad", dia "across", docho "receive", kinesia "movement“.

Inability to perform rapid, alternating movements.

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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.
slide7
Opsoclonus:

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

  • Myoclonus:

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

slide8
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.

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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
slide12
Toxic
    • Alcohol
    • Anticonvulsants (phenytoin, carbamazepine)
    • Benzodiazepines
    • Barbiturates
    • Antihistamines
    • Lithium
    • Heavy metals (lead, mercury, thallium)
slide13
Mass lesions
    • Tumors: brain stem, cerebellum
    • Vascular lesions (AVM)
    • Abscesses
  • Hydrocephalus
  • Trauma
    • Head
    • Neck (vertebral artery dissection)
slide14
Vascular events
    • Stroke, hemorrhage
  • Paraneoplastic disorders
    • Opsoclonus-myoclonus syndrome: Occult Neuroblastoma or ganglioneuroblastoma
  • Sensory ataxia
    • Miller Fisher syndrome: ataxia, areflexia, ophtalmoplegia(vertical gaze)
slide15
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.
slide17
Physical exam
    • Complete neurological exam
      • Mental status
      • Cranial nerves
      • Cerebellar testing
      • Sensation
      • Strength
      • Meningeal signs
      • Reflexes
      • Gait
slide18
Initial ancillary tests
    • Laboratory
      • Urine/serum drug screen/level
      • CBC
      • Electrolytes
    • Imaging
      • CT brain
      • MRI brain
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