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Morning Report
Acute Ataxia
8/31/09
Lorena Muñiz, MD
Definitions
 Ataxia: From Greek ataktos: without
order.
Failure of muscular coordination.
Pathologic abnormality of organization or
modulation of movement.
Disturbances in the control of body
posture, motor coordination, speech
control and eye movements.
 Dizziness: impairment in spatial
perception and stability, considered
imprecise.
 Vertigo: sensation of spinning or
having one's surroundings spin about
them.
 Dysmetria: From English difficult to
measure.
Lack of coordination of movement
typified by the undershoot and/or
overshoot of intended position with
the hand, arm, leg, or eye.
 Dysdiadochokinesia: From Greek dys
"bad", dia "across", docho "receive",
kinesia "movement“.
Inability to perform rapid, alternating
movements.
 Dysarthria:
Motor speech disorder resulting from
neurological injury, characterised by
poor articulation
 Nystagmus: form of involuntary eye
movement characterized by
alternating smooth pursuit in one
direction and rapid movement in the
other direction.
 Opsoclonus:
Rapid, involuntary, multivectorial
(horizontal and vertical),
unpredictable, conjugate fast eye
movements.
 Myoclonus:
Brief, involuntary twitching of a muscle
or a group of muscles.
 Romberg's test: assess the dorsal
columns of the spinal cord. Indication
of loss of the sense of position,
patient loses balance when standing
erect, feet together, and eyes closed.
+Romberg: ataxia is sensory in
nature, depending on loss of
proprioception.
– Romberg: ataxia is cerebellar.
Types of Ataxia
 Cerebellar ataxia
1. Vestibulocerebellum impaired
balance and control of eye
movements, postural instability.
2. Spinocerebellum wide-based
"drunken sailor" gait.
3. Cerebrocerebellum disturbances in
carrying out voluntary, planned
movements.
 Sensory ataxia: Loss of
proprioception (joint position sense),
dysfunction of the dorsal columns of
the spinal cord, spinal nerve roots or
peripheral nerves.
 Vestibular ataxia: Loss of balance,
in acute and unilateral cases is
associated with prominent vertigo,
nausea and vomiting.
Etiology
 Infectious/immune-mediated
cerebellar disorders
 Acute cerebellar ataxia*
 Post infectious cerebellitis
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Acute demyelinating encephalomyelitis
Systemic infections
Brainstem encephalitis
Multiple sclerosis
 Toxic
 Alcohol
 Anticonvulsants (phenytoin,
carbamazepine)
 Benzodiazepines
 Barbiturates
 Antihistamines
 Lithium
 Heavy metals (lead, mercury, thallium)
 Mass lesions
 Tumors: brain stem, cerebellum
 Vascular lesions (AVM)
 Abscesses
 Hydrocephalus
 Trauma
 Head
 Neck (vertebral artery dissection)
 Vascular events
 Stroke, hemorrhage
 Paraneoplastic disorders
 Opsoclonus-myoclonus syndrome: Occult
Neuroblastoma or ganglioneuroblastoma
 Sensory ataxia
 Miller Fisher syndrome: ataxia, areflexia,
ophtalmoplegia(vertical gaze)
 Paretic ataxia
 Other neurologic disorders
 Basilar migraine: vertigo, hemiparesis,
cranial nerve dysfunction, N/V/HA
 Benign paroxysmal vertigo
 Seizures
 Inborn error of metabolism
 Functional
Work up
 History:
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Prior or current symptoms of infection.
Recent immunizations.
Headaches, vomit, diplopia.
ROS.
Drug ingestion.
Head on neck trauma.
Similar episodes in past or in family.
 Physical exam
 Complete neurological exam
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Mental status
Cranial nerves
Cerebellar testing
Sensation
Strength
Meningeal signs
Reflexes
Gait
 Initial ancillary tests
 Laboratory
 Urine/serum drug screen/level
 CBC
 Electrolytes
 Imaging
 CT brain
 MRI brain
Thank you!