Ataxia: Difference between revisions
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**Intoxications with diminished alertness | **Intoxications with diminished alertness | ||
***[[Ethanol]] | ***[[Ethanol]] | ||
***[[Sedative | ***[[Sedative/hypnotic toxicity]] | ||
***[[Toxic alcohols]] | ***[[Toxic alcohols]] | ||
***[[GHB]] | ***[[GHB]] | ||
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***[[Heavy metal toxicity|Lead, organic mercurials]] | ***[[Heavy metal toxicity|Lead, organic mercurials]] | ||
***[[Carbon monoxide]] | ***[[Carbon monoxide]] | ||
***[[Acute radiation | ***[[Acute radiation syndrome]] | ||
***[[Lithium toxicity]] | ***[[Lithium toxicity]] | ||
***[[Mushroom toxicity]] | ***[[Mushroom toxicity]] | ||
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**Conditions affecting predominantly the peripheral nervous system | **Conditions affecting predominantly the peripheral nervous system | ||
***Peripheral neuropathy | ***Peripheral neuropathy | ||
***Vestibulopathy (e.g. [[vestibular neuritis]], [[ | ***Vestibulopathy (e.g. [[vestibular neuritis]], [[labyrinthitis]]) | ||
***[[Guillain | ***[[Guillain-Barre]] | ||
**Miscellaneous | **Miscellaneous | ||
***[[Acute mountain sickness]] | ***[[Acute mountain sickness]] | ||
| Line 92: | Line 92: | ||
***Post vaccination ([[varicella]]) | ***Post vaccination ([[varicella]]) | ||
***[[Vasculitis]] | ***[[Vasculitis]] | ||
***[[Epilepsy]] | |||
==Evaluation== | ==Evaluation== | ||
Revision as of 23:33, 1 October 2019
For pediatric patients see ataxia (peds)
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
- Intoxications with relatively preserved alertness
- Other metabolic disorders
- Disorders predominantly of the nervous system
- Conditions affecting predominantly one region of the CNS
- Hemorrhage, vertebral and carotid artery dissection
- Infarction
- Lateral medullary syndrome
- Degenerative changes
- Abscess
- Brain tumor
- Head trauma
- Hydrocephalus, normal pressure hydrocephalus, VP shunt malfunction
- Parkinson's disease
- Prion disease
- Heat stroke
- Leukostasis and hyperleukocytosis
- Cervical spondylosis
- Posterior column disorders
- Conditions affecting predominantly the peripheral nervous system
- Peripheral neuropathy
- Vestibulopathy (e.g. vestibular neuritis, labyrinthitis)
- Guillain-Barre
- Miscellaneous
- Acute mountain sickness
- Syphilis
- Tick paralysis
- Ciguatera, neurotoxic shellfish poisoning
- African trypanosomiasis
- Tympanic membrane rupture
- Legionella
- Paraneoplastic syndromes
- Postinfectious cerebellitis (acute cerebellar ataxia)
- Post vaccination (varicella)
- Vasculitis
- Epilepsy
- Conditions affecting predominantly one region of the CNS
Evaluation
Management
- Treat underlying pathology