Ataxia: Difference between revisions

Revision as of 06:37, 30 August 2015

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

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
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
- Conditions affecting predominantly the peripheral nervous system
  - Peripheral neuropathy
  - Vestibulopathy

Work-Up

Depends on rapidity of symptoms
If acute consider CT, MRI, LP

Management

Disposition

References

Authors:

@@ Line 5: / Line 5: @@
 **Sensory ataxia may be compensated to a degree w/ visual sensory information
-==Diagnosis==
+==Clinical Features==
-#Sensory versus motor ataxia
+*Sensory versus motor ataxia
-##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 w/ 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 w/ 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 w/ 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 w/ series of jerky movements
+==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
+*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
+**Conditions affecting predominantly the peripheral nervous system
+***Peripheral neuropathy
+***Vestibulopathy
 ==Work-Up==
@@ Line 24: / Line 59: @@
 *If acute consider CT, MRI, LP
-==DDX==
+==Management==
-#Systemic conditions
-##Intoxications with diminished alertness
+==Disposition==
-###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
-#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
-##Conditions affecting predominantly the peripheral nervous system
-###Peripheral neuropathy
-###Vestibulopathy
 ==See Also==
@@ Line 65: / Line 69: @@
 *[[Cerebellar Stroke]]
-==Source==
+==References==
-Tintinalli
 [[Category:Neuro]]