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 | **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 | ***If ataxia worsens with loss of visual input suggestive of sensory ataxia | ||
***If ataxia does not significantly change | ***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 | ***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 | ***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 | ***[[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 | ***[[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 | ||
*** | ***[[ICH|Hemorrhage]], [[vertebral and carotid artery dissection]] | ||
*** | ***[[Stroke|Infarction]] | ||
*** | ***[[Lateral medullary syndrome]] | ||
****Degenerative changes | ****Degenerative changes | ||
*** | ***[[Brain abscess|Abscess]] | ||
*** | ***[[Brain tumor]] | ||
*** | ***[[Head trauma]] | ||
*** | ***[[Hydrocephalus]], [[normal pressure hydrocephalus]], [[VP shunt malfunction]] | ||
*** | ***[[Parkinson's disease]] | ||
*** | ***[[Prion disease]] | ||
***[[Heat stroke]] | |||
*** | ***[[Leukostasis and hyperleukocytosis]] | ||
*** | ***Cervical spondylosis | ||
***[[spinal cord injury|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]] | |||
== | ==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
- 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