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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


Lorena Muñiz, MD

  • 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.

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

Inability to perform rapid, alternating movements.


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.

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.
  • Infectious/immune-mediated cerebellar disorders
    • Acute cerebellar ataxia*
      • Post infectious cerebellitis
    • Acute demyelinating encephalomyelitis
    • Systemic infections
    • Brainstem encephalitis
    • Multiple sclerosis
    • 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
Initial ancillary tests
    • Laboratory
      • Urine/serum drug screen/level
      • CBC
      • Electrolytes
    • Imaging
      • CT brain
      • MRI brain