Ataxia: Difference between revisions

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''For pediatric patients see [[ataxia (peds)]]''
==Background==
==Background==
*Sign of a variety of disease processes; not a diagnosis in itself
*Sign of a variety of disease processes; not a diagnosis in itself
*Isolated lesion of cerebellum is NOT the most common cause
*Isolated lesion of cerebellum is NOT the most common cause
*Must distinguish between motor (cerebellar) and sensory (cord, peripheral nerves) ataxia
*Must distinguish between motor (cerebellar) and sensory (cord, peripheral nerves) ataxia
**Sensory ataxia may be compensated to a degree w/ visual sensory information
**Sensory ataxia may be compensated to a degree with visual sensory information


==Clinical Features==
==Clinical Features==
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**Romberg test
**Romberg test
***Comparison of posture stability when eyes are open versus eyes closed
***Comparison of posture stability when eyes are open versus eyes closed
***If ataxia worsens w/ loss of visual input suggestive of sensory ataxia
***If ataxia worsens with loss of visual input suggestive of sensory ataxia
***If ataxia does not significantly change w/ eyes closed suggests motor ataxia
***If ataxia does not significantly change with eyes closed suggests motor ataxia
*Systemic versus isolated nervous system disease
*Systemic versus isolated nervous system disease
*CNS versus PNS
*CNS versus PNS
*Cerebellar versus posterior column (proprioceptive)
*Cerebellar versus posterior column (proprioceptive)
**Finger to nose
**Finger to nose
***Performing test w/ eyes closed tests proprioception
***Performing test with eyes closed tests proprioception
**Heel-to-shin test
**Heel-to-shin test
***Posterior column disease: Difficult locating knee
***Posterior column disease: Difficult locating knee
***Cerebellar disease: Action completed w/ series of jerky movements
***Cerebellar disease: Action completed with series of jerky movements


==Differential Diagnosis==
==Differential Diagnosis==
*Systemic conditions
*Systemic conditions
**Intoxications with diminished alertness
**Intoxications with diminished alertness
***Ethanol
***[[Ethanol]]
***Sedative-hypnotics
***[[Sedative/hypnotic toxicity]]
***[[Toxic alcohols]]
***[[GHB]]
***[[Benzodiazepine toxicity]]
***[[TCA toxicity]]
***[[Antipsychotic toxicity]]
***[[Inhalant abuse]], [[hydrocarbon toxicity]]
***[[Pentobarbital]]
***[[Chloral hydrate toxicity]]
***[[Marijuana toxicity]]
***[[Phencyclidine toxicity]]
**Intoxications with relatively preserved alertness
**Intoxications with relatively preserved alertness
***Phenytoin
***[[phenytoin toxicity|Phenytoin]], [[fosphenytoin]], [[Keppra]]
***Carbamazepine
***[[Carbamazepine toxicity|Carbamazepine]], [[oxcarbazepine]]
***Valproic acid
***[[Valproic acid toxicity|Valproic acid]]
***Lead, organic mercurials
***[[Heavy metal toxicity|Lead, organic mercurials]]
***[[Carbon monoxide]]
***[[Acute radiation syndrome]]
***[[Lithium toxicity]]
***[[Mushroom toxicity]]
***[[Lacosamide]]
***[[Arsenic toxicity]]
***[[Gabapentin]]
***[[Marijuana toxicity]]
***[[Phencyclidine toxicity]]
***[[Lindane]]
***[[Vitamin A toxicity]]
**Other metabolic disorders
**Other metabolic disorders
***Hyponatremia
***[[Hyponatremia]]
***Inborn errors of metabolism
***[[Hypernatremia]]
***Wernicke's disease
***[[Hypomagnesemia]]
***[[Inborn errors of metabolism]]
***[[Wernicke disease]]
***[[Vitamin B7 deficiency]]
***[[Vitamin E deficiency]]
*Disorders predominantly of the nervous system
*Disorders predominantly of the nervous system
**Conditions affecting predominantly one region of the CNS
**Conditions affecting predominantly one region of the CNS
***Cerebellum
***[[ICH|Hemorrhage]], [[vertebral and carotid artery dissection]]
****Hemorrhage
***[[Stroke|Infarction]]
****Infarction
***[[Lateral medullary syndrome]]
****Degenerative changes
****Degenerative changes
****Abscess
***[[Brain abscess|Abscess]]
***Cortex
***[[Brain tumor]]
****Frontal tumor, hemorrhage, or trauma
***[[Head trauma]]
****Hydrocephalus
***[[Hydrocephalus]], [[normal pressure hydrocephalus]], [[VP shunt malfunction]]
***Subcortical
***[[Parkinson's disease]]
****Thalamic infarction or hemorrhage
***[[Prion disease]]
****Parkinson's disease
***[[Heat stroke]]
****Normal pressure hydrocephalus
***[[Leukostasis and hyperleukocytosis]]
***Spinal cord
***Cervical spondylosis
****Cervical spondylosis
***[[spinal cord injury|Posterior column disorders]]
****Posterior column disorders
**Conditions affecting predominantly the peripheral nervous system
**Conditions affecting predominantly the peripheral nervous system
***Peripheral neuropathy
***Peripheral neuropathy
***Vestibulopathy
***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]]


==Diagnosis==
==Evaluation==
*Depends on rapidity of symptoms
*Depends on rapidity of symptoms and additional features
*If acute consider CT, MRI, LP
*If acute consider [[head CT|CT]], [[brain MRI|MRI]], [[LP]]


==Management==
==Management==
*Treat underlying pathology


==Disposition==
==Disposition==
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*[[Weakness]]
*[[Weakness]]
*[[Cerebellar Stroke]]
*[[Cerebellar Stroke]]
*[[Focal neuro deficits]]


==References==
==References==
 
<references/>
[[Category:Neurology]]
[[Category:Neurology]]
[[Category:Symptoms]]

Revision as of 00:27, 2 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
  • 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

Differential Diagnosis

Evaluation

  • Depends on rapidity of symptoms and additional features
  • If acute consider CT, MRI, LP

Management

  • Treat underlying pathology

Disposition

See Also

References