Ataxia

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

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

Evaluation

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

Management

Treat underlying pathology

Disposition

See Also

References

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