Ataxia: Difference between revisions
Elcatracho (talk | contribs) |
|||
| (One intermediate revision by one other user not shown) | |||
| Line 12: | Line 12: | ||
***If ataxia worsens with 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 with eyes closed suggests motor ataxia | ***If ataxia does not significantly change with eyes closed suggests motor ataxia | ||
**Finger-to-nose, heel-to-shin, rapid alternating movements | |||
***If abnormal with eyes open, suggests motor ataxia | |||
***If abnormal with eyes closed, suggests sensory ataxia | |||
*Systemic versus isolated nervous system disease | *Systemic versus isolated nervous system disease | ||
*CNS versus PNS | *CNS versus PNS | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 102: | Line 99: | ||
==Disposition== | ==Disposition== | ||
===Admission=== | |||
*Patients with acute or subacute cases of ataxia should be admitted if benign etiology cannot be established | |||
*Admit patient if they cannot ambulate safely on their own | |||
===Discharge=== | |||
*Discharge patients with mild or reversible symptoms as long as they are AAOX4 and can ambulate safely. | |||
*Consider follow-up with neurology or primary care | |||
==See Also== | ==See Also== | ||
Latest revision as of 02:32, 23 September 2021
This page is for adult patients. 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 (failure to transmit proprioception) versus motor (cerebellar) 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
- Finger-to-nose, heel-to-shin, rapid alternating movements
- If abnormal with eyes open, suggests motor ataxia
- If abnormal with eyes closed, suggests sensory ataxia
- Romberg test
- Systemic versus isolated nervous system disease
- CNS versus PNS
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
Disposition
Admission
- Patients with acute or subacute cases of ataxia should be admitted if benign etiology cannot be established
- Admit patient if they cannot ambulate safely on their own
Discharge
- Discharge patients with mild or reversible symptoms as long as they are AAOX4 and can ambulate safely.
- Consider follow-up with neurology or primary care