Ataxia: Difference between revisions

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{{Adult top}} [[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 w/ visual sensory information
**Sensory ataxia may be compensated to a degree with visual sensory information


==Diagnosis==
==Clinical Features==
#Sensory versus motor ataxia
*Sensory (failure to transmit proprioception) versus motor (cerebellar) 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 with 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 with eyes closed suggests motor ataxia
#Systemic versus isolated nervous system disease
**Finger-to-nose, heel-to-shin, rapid alternating movements
#CNS versus PNS
***If abnormal with eyes open, suggests motor ataxia
#Cerebellar versus posterior column (proprioceptive)
***If abnormal with eyes closed, suggests sensory ataxia
##Finger to nose
*Systemic versus isolated nervous system disease
###Performing test w/ eyes closed tests proprioception
*CNS versus PNS
##Heel-to-shin test
###Posterior column disease: Difficult locating knee
###Cerebellar disease: Action completed w/ series of jerky movements


==Work-Up==
==Differential Diagnosis==
*Depends on rapidity of symptoms
*Systemic conditions
*If acute consider CT, MRI, LP
**Intoxications with diminished alertness
***[[Ethanol]]
***[[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
***[[phenytoin toxicity|Phenytoin]], [[fosphenytoin]], [[Keppra]]
***[[Carbamazepine toxicity|Carbamazepine]], [[oxcarbazepine]]
***[[Valproic acid toxicity|Valproic acid]]
***[[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
***[[Hyponatremia]]
***[[Hypernatremia]]
***[[Hypomagnesemia]]
***[[Inborn errors of metabolism]]
***[[Wernicke disease]]
***[[Vitamin B7 deficiency]]
***[[Vitamin E deficiency]]
*Disorders predominantly of the nervous system
**Conditions affecting predominantly one region of the CNS
***[[ICH|Hemorrhage]], [[vertebral and carotid artery dissection]]
***[[Stroke|Infarction]]
***[[Lateral medullary syndrome]]
****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
***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]]


==DDX==
==Evaluation==
#Systemic conditions
*Depends on rapidity of symptoms and additional features
##Intoxications with diminished alertness
*If acute consider [[head CT|CT]], [[brain MRI|MRI]], [[LP]]
###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


==Source==
==Management==
Tintinalli
*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


[[Category:Neuro]]
===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==
*[[Altered Mental Status]]
*[[Ataxia (Peds)]]
*[[Weakness]]
*[[Cerebellar Stroke]]
*[[Focal neuro deficits]]
 
==References==
<references/>
[[Category:Neurology]]
[[Category:Symptoms]]

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
  • Systemic versus isolated nervous system disease
  • CNS versus PNS

Differential Diagnosis

Evaluation

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

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

See Also

References

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