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Ataxia

The cerebellum coordinates movements and is located in the posterior cranial fossa. Ataxia is an inability to make smooth movements and usually manifests as an unsteady gait. Acute ataxia needs to rule out life-threatening causes like meningitis or increased intracranial pressure, while chronic ataxia may be caused by brain tumors, hereditary ataxias, or other neurological issues. Evaluation includes imaging and spinal taps, and treatment depends on the underlying cause.

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700 views23 pages

Ataxia

The cerebellum coordinates movements and is located in the posterior cranial fossa. Ataxia is an inability to make smooth movements and usually manifests as an unsteady gait. Acute ataxia needs to rule out life-threatening causes like meningitis or increased intracranial pressure, while chronic ataxia may be caused by brain tumors, hereditary ataxias, or other neurological issues. Evaluation includes imaging and spinal taps, and treatment depends on the underlying cause.

Uploaded by

kara_korum
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
  • Ataxia Overview: Introduction to ataxia with an illustrated depiction focusing on the cerebellum's role.
  • The Cerebellum: Explains the cerebellum's function in coordinating movement and implications of midline lesions.
  • The Peduncles: Describes the role of the inferior, middle, and superior peduncles in proprioception and motor function.
  • Definition of Ataxia: Defines ataxia and common symptoms such as unsteady gait and difficulties in movement coordination.
  • Approaching Ataxia: Outlines the systematic approach to diagnosing ataxia, including medical history and potential causes.
  • Acute Ataxia: Discusses immediate concerns in acute cases such as ruling out severe conditions like trauma and infections.
  • Life-threatening Causes of Ataxia: Lists critical conditions that may present with ataxia, emphasizing the need for urgent evaluation.
  • Evaluation: Explains diagnostic tools for evaluating ataxia, including imaging and lab tests.
  • Acute Cerebellar Ataxia: Details specific considerations for acute cerebellar ataxia, primarily in young children.
  • Ingestions/Toxins: Lists substances that could potentially contribute to ataxia due to ingestion or exposure.
  • Guillain-Barré Syndrome: Outlines characteristics and key symptoms of Guillain-Barré Syndrome related to ataxia.
  • Conversion Reaction: Describes symptoms and demographic factors of conversion reaction, which might mimic ataxia.
  • Other Considerations: Highlights other potential differential diagnoses for ataxia-like symptoms.
  • Intermittent Ataxia: Defines various causes of intermittent ataxia including migraines and pseudoataxia.
  • Basilar Migraine: Explores the association between basilar migraines and episodic ataxia.
  • Pseudoataxia: Discusses pseudotaxia as a form of epileptic ataxia with seizure-related symptoms.
  • Metabolic Disease: Covers metabolic disorders that can manifest through symptoms of ataxia.
  • Chronic Ataxia: Differentiates chronic ataxia from acute cases, highlighting diagnostic imaging considerations.
  • Brain Tumors: Provides an overview of brain tumors that can cause ataxia.
  • Hereditary Ataxias: Lists hereditary conditions associated with ataxia.
  • Management: Summarizes treatment and management options for various causes of ataxia.

ATAXIA

The Cerebellum

Coordinates or fine-tunes movements Located in the posterior cranial fossa Bi-hemispheric with ipsilateral function Midline lesions cause truncal instability (vermis)

The Peduncles

Proprioception and sensory afferent via the INFERIOR PEDUNCLES Frontal motor cortex impulses travel via the MIDDLE PEDUNCLES Purkinje fibers course along the SUPERIOR PEDUNCLES to muscular tracts

Ataxia

Inability to make smooth, coordinated movements Usually manifests as unsteady gait May be difficult to access in younger children Vast differential, but can be narrowed down

Approaching Ataxia

History and physical Define time course Recent illnesses? Trauma? Access to medications?

Acute Ataxia

Need to rule out the bad stuff Focal deficits, history of trauma, evidence of ICP, shunt malfunction Fever, nuchal rigidity, toxic appearance

Life-threatening Causes of Ataxia


Meningitis Increased ICP with herniation (2 to mass, bleed, obstruction) Drug intoxication These rarely present as ataxia alone

Evaluation

Computed Tomography for evidence of ICH, hydrocephalus, Posterior fossa tumors Consider spinal tap for meningitis/encephalitis Question caregivers about medicines If negative history, physical and workup then consider other causes

Acute Cerebellar Ataxia


Children ages 1-3 yrs Diagnosis of exclusion Follows a viral illness varicella, coxsackievirus, echovirus and is suspected autoimmune response

Acute Cerebellar Ataxia

Explosive onset and most severe in beginning Wide-based gait, unsteadiness, imbalance while sitting, horizontal nystagmus (50%) and dysarthria May have vomiting, but fever and nuchal rigidity should be absent

Acute Cerebellar Ataxia


Normal CT CSF is typically normal, but may have mild pleocytosis (increases with time) May last weeks to months Prognosis is excellent

Ingestions/Toxins

Alcohol Phenytoin Carbamazepine Benzos Antihistimines

Dextromethorphan Lead Phenothiazines Ethylene glycol Mercury

These would be based on possibility of exposure

Guillain-Barr syndome

Miller Fisher Variant Ataxia, opthalmoplegia and areflexia Usually preceded by viral illness (5-10d) Paralysis of upward, then lateral and finally downward gaze Limb ataxia>truncal ataxia Elevated protein in CSF Recovery in weeks to months

Conversion Reaction

Usually girls age 10-15 Involuntary, but provides a secondary gain Sits without difficulty, but sways upon standing No wide-based gait Normal strength, tone, and reflexes

Other things to consider


Postconcussion Labrynthitis Occult intoxication MS Benign vertigo

Intermittent Ataxia

Basilar migraines Pseudoataxia Metabolic diseases

Basilar Migraine

Recurrent attacks of ataxia followed by severe throbbing headaches May have vision loss, vertigo, parasthesias May evolve into classic migraines N/V in less than 1/3 of cases EEG to rule out benign occipital epilepsy

Pseuodataxia (epileptic ataxia)


Sudden and episodic May be only manifestation of seizure Can be confused with seizure med toxicity May be confused/disoriented Clonazepam and valproate are drugs of choice

Metabolic disease

Hartnup disease DD, photosensitive, decreased tone, episodic ataxia Maple Syrup Urine Disease neonatal seizures, encephalopathy, urine odor and recurrent ataxia Pyruvate Dehydrogenase Deficiency intermittent ataxia and lactic acidosis

Chronic

May be just as worrisome as acute CT/MRI Hydrocephalus Posterior fossa tumors Congenital/hereditary

Brain tumors

Cerebellar astrocytoma Brainstem glioma Ependymoma Meduloblastoma Can also be 2 to supratentorial masses

Hereditary ataxias

Ataxia-telengectasia Friedrich Ataxia Ramsey-Hunt Syndrome

Management

Dependent on cause Most common causes are self-limiting and have great prognosis Head-protection may be necessary Consult neurology Increased concern if other abnormal findings on neuro exam

ATAXIA
The Cerebellum Coordinates or “fine-tunes” movements Located in the posterior cranial fossa Bi-hemispheric with ipsilat
The Peduncles Proprioception and sensory afferent via the INFERIOR PEDUNCLES Frontal motor cortex impulses travel via t
Ataxia Inability to make smooth, coordinated movements Usually manifests as unsteady gait May be difficult to access i
Approaching Ataxia History and physical Define time course Recent illnesses? Trauma? Access to medications?
Acute Ataxia Need to rule out the bad stuff Focal deficits, history of trauma, evidence of ICP, shunt malfunction Feve
Life-threatening Causes of Ataxia Meningitis Increased ICP with herniation (2° to mass, bleed, obstruction) Drug into
Evaluation Computed Tomography for evidence of ICH, hydrocephalus, Posterior fossa tumors Consider spinal tap for meni
Acute Cerebellar Ataxia Children ages 1-3 yrs Diagnosis of exclusion Follows a viral illness – varicella, coxsackievir
Acute Cerebellar Ataxia Explosive onset and most severe in beginning Wide-based gait, unsteadiness, imbalance while sit

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