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Ataxia
From WikEM
Contents
Background
- Sign of a variety of disease processes; not a diagnosis in itself
- Isolated lesion of cerebellum is NOT the most common cause
- Must distinguish between motor (cerebellar) and sensory (cord, peripheral nerves) ataxia
- Sensory ataxia may be compensated to a degree with visual sensory information
Clinical Features
- Sensory versus motor ataxia
- Romberg test
- Comparison of posture stability when eyes are open versus eyes closed
- If ataxia worsens with loss of visual input suggestive of sensory ataxia
- If ataxia does not significantly change with eyes closed suggests motor ataxia
- Romberg test
- Systemic versus isolated nervous system disease
- CNS versus PNS
- Cerebellar versus posterior column (proprioceptive)
- Finger to nose
- Performing test with eyes closed tests proprioception
- Heel-to-shin test
- Posterior column disease: Difficult locating knee
- Cerebellar disease: Action completed with series of jerky movements
- Finger to nose
Differential Diagnosis
- Systemic conditions
- Intoxications with diminished alertness
- Ethanol
- Sedative-hypnotics
- Intoxications with relatively preserved alertness
- Phenytoin
- Carbamazepine
- Valproic acid
- Lead, organic mercurials
- Other metabolic disorders
- Hyponatremia
- Inborn errors of metabolism
- Wernicke's disease
- Intoxications with diminished alertness
- Disorders predominantly of the nervous system
- Conditions affecting predominantly one region of the CNS
- Cerebellum
- Hemorrhage
- Infarction
- Degenerative changes
- Abscess
- Cortex
- Frontal tumor, hemorrhage, or trauma
- Hydrocephalus
- Subcortical
- Thalamic infarction or hemorrhage
- Parkinson's disease
- Normal pressure hydrocephalus
- Spinal cord
- Cervical spondylosis
- Posterior column disorders
- Cerebellum
- Conditions affecting predominantly the peripheral nervous system
- Peripheral neuropathy
- Vestibulopathy
- Conditions affecting predominantly one region of the CNS
Evaluation
- Depends on rapidity of symptoms
- If acute consider CT, MRI, LP
