Cerebellar ataxia
The content of the article:
- Causes
- Forms of cerebellar ataxia
- Cerebellar ataxia symptoms
- Diagnostics
-
Cerebellar ataxia treatment
Physiotherapy
- Prevention
- Consequences and complications
- Video
Ataxia is a term referring to various movement disorders; cerebellar ataxia is a movement disorder that occurs due to damage to the cerebellum, since it is the cerebellum that is the part of the brain that is responsible for balance, coordination of movements and muscle tone.
Cerebellar injury leads to cerebellar ataxia
In addition to cerebellar, there is also sensitive and vestibular ataxia, they are caused by damage to other parts of the brain.
Causes
Normally, voluntary movements are ensured by precise coordination between synergistic and antagonistic muscles. The interaction between them is controlled by the cerebellum, which has connections with all structures of the central nervous system that are involved in motor function. The cerebellum can be called the main coordination center of movement; it receives information from the structures of the brain and ensures the synchronization and accuracy of muscle contractions, also processing information about the movement of the body in space. This ensures the accuracy and smoothness of voluntary movements. When the cerebellum is damaged, there is a desynchronization of muscle contractions of different groups, which is manifested by ataxia.
The causes of damage to the cerebellum can be as follows:
- acute violation of cerebral circulation (stroke), affecting the cerebellum;
- traumatic brain injury;
- infectious cerebellitis, including of parasitic origin;
- cerebellar abscess;
- acute and chronic intoxication, including drug (anticonvulsant, hypnotics, anxiolytics, neuroleptics, bismuth drugs, chemotherapeutic drugs, etc.);
- alcoholism;
- deficiency of vitamins B1, B12, E;
- heatstroke;
- hypoglycemia;
- hypothyroidism;
- multiple sclerosis;
- Arnold-Chiari anomalies;
- canalopathies (diseases caused by genetically determined defects in ion channels);
- genetic diseases (Friedreich's ataxia);
- prion diseases;
- tumors (especially often affecting the cerebellum, medulloblastoma, cerebellopontine schwannoma and hemangioblastoma);
- paraneoplastic degeneration of the cerebellum (secondary tumor lesion of the cerebellum);
- Hakimi-Adams syndrome (normotensive hydrocephalus);
- mitochondrial encephalomyopathies (Leigh's disease, MELAS syndrome, etc.);
- idiopathic degenerative ataxia due to neurodegenerative diseases (parenchymal cortical cerebellar atrophy, multiple systemic atrophy, Pierre-Marie hereditary cerebellar ataxia);
- hereditary and genetic metabolic disorders (aciduria, Hartnup disease, Gaucher disease type 3, Tay-Sachs disease, Refsum disease, etc.).
Forms of cerebellar ataxia
Different parts of the cerebellum (worm and hemispheres) are responsible for different types of movement; in accordance with the predominant lesion of one or another anatomical structure of the organ, two forms of pathology are distinguished:
- dynamic - caused by damage to the hemispheres, characterized by discoordination of movements in the limbs;
- static-locomotor - caused by damage to the worm, as a result, gait is disturbed and stability suffers.
In addition, cerebellar ataxia can be:
- acute - caused by acute causes, for example, stroke or traumatic brain injury;
- chronic - caused by long-term lesions of the cerebellum, for example, in chronic alcoholism.
By the nature of distribution:
- generalized - all voluntary movements are violated;
- isolated - some types of movements are impaired, for example, walking, speaking, hand movements.
Also, ataxia is unilateral and bilateral.
Cerebellar ataxia symptoms
The manifestation of cerebellar ataxia depends on which structure of the cerebellum was damaged.
Cerebellar ataxia is characterized by impaired coordination of voluntary movements
When the worm is damaged, the ability to maintain a stable body position is disrupted, the patient sways in a standing position, for stability he has to balance with his arms, spread his legs wide, otherwise he may fall back. The gait resembles the gait of a drunk person, it is uncertain, the patient is especially unstable when turning, he staggers, the body is sharply straightened, the legs are raised too high while walking.
If the hemispheres are affected, gait disturbance, unstable position of the body can also be observed, while the patient "falls" on the side of the lesion. The main manifestation is awkward and inconsistent movements of the limbs, which impede the implementation of accurate actions.
With the progression of the condition, dysphagia (impaired swallowing) and dysarthria (impaired speech) join the described disorders.
Signs of ataxia are accompanied by symptoms characteristic of the underlying disease.
Diagnostics
When symptoms of ataxia appear, the patient undergoes a neurological examination. It requires not only confirmation of the cerebellar nature of the pathology, but also the identification of the condition that led to its development.
In the case of unexpressed symptoms, coordination (functional) tests are performed, for example:
| Try | Description |
| Support reaction check | The patient is asked to stand with the feet shifted. It is difficult to maintain this position during ataxia, the patient will stagger, lose stability. |
| Checking stability in the Romberg pose | The patient is asked to stand with the feet tightly together, the head elevated and the arms extended forward. Ataxia is manifested by an unstable position of the body, the patient begins to sway and may fall. |
| Testing stability in a sensitized (complicated) Romberg position | The patient is asked to stand in such a way that the toe of one leg rests on the heel of the other leg, while slightly raising his head and extending his arms. With ataxia, he will not be able to maintain stability even for a short time. |
| Jump reaction test | Normally, if a person standing with shifted legs is threatened to fall to the side, the leg on this side moves in the direction of the fall, and the other leg comes off the floor. In ataxia, the doctor stands behind the patient and, holding him for insurance, pushes him aside. In ataxia, even a small push will cause a fall, this is the so-called positive pushing symptom. |
With confirmed ataxia, appoint:
- neuroimaging studies: CT (computed tomography of the brain), MRI (magnetic resonance imaging of the brain);
- neurophysiological studies: electroneuromyography, evoked potential method.
Using these methods, functional and structural changes in the central and peripheral nervous system are determined.
If hereditary atactic diseases are suspected, DNA analysis of patients is done. If necessary, the patient or his relatives are referred for medical genetic counseling. If there is reason to suspect a hereditary pathology in the fetus, prenatal DNA analysis is performed.
A thorough search for the causes of ataxia may include a wide range of studies, including imaging techniques (search for tumors), blood tests for hormones (search for endocrine disorders), biochemical studies (search for metabolic disorders), toxicological analysis (search for possible intoxications), etc. Patient can be sent for consulting to related specialists - cardiologist, endocrinologist, neurosurgeon and others.
Cerebellar ataxia treatment
Therapeutic tactics depend on the cause that caused the ataxia, efforts are aimed at treating the underlying disease. For example, if the cause of the pathology is a resectable tumor, the treatment will be surgical, and if it is unresectable, chemotherapy or radiotherapy, if the reason is hypovitaminosis, vitamin therapy is prescribed, treatment of traumatic brain injuries is carried out according to the scheme adopted for this type of injury, and the therapy of multiple sclerosis is in taking immunomodulatory drugs. In such cases, treatment of the underlying disease is usually sufficient for the symptoms of cerebellar ataxia to completely disappear or at least stop progressing and diminish.
There is information in the literature on the successful use of certain drugs (pregabalin, amantadine, thyrotropin-releasing factor, buspirone, L-5-hydroxytryptophan) in ataxia of degenerative etiology, however, clinical studies that could confirm this information have not been conducted. There is also evidence of the effectiveness of inosiazide and a number of anticonvulsants (carbamazepine, clonazepam, topiramate) in cerebellar ataxia, but these data also need to be verified and confirmed.
Currently, research is underway on the treatment of hereditary ataxias by methods of cell and gene therapy, these areas are assessed as the most promising in solving this problem.
Physiotherapy
It is one of the key methods of treatment and rehabilitation for patients with cerebellar ataxia. Physiotherapy can improve coordination, support motor functions, and prevent the development of muscle atrophy and contractures. Complex programs have been developed, including exercises aimed at restoring feedback, special exercises for training cerebellar functions (Frenkel's method), proprioceptive muscle relief (PMF, proprioceptive muscle facilitation).
There are specific exercises to help stimulate cerebellar function.
The greatest effect can be achieved with the combined use of drug and physical therapy.
Prevention
Prevention of cerebellar ataxia consists of preventing the conditions that lead to it, whenever possible. For example, refusal from alcohol abuse, use of a helmet during exercises fraught with cranial injuries, timely treatment of somatic diseases. Medical genetic counseling is a measure for the prevention of hereditary atactic diseases.
Consequences and complications
With progressive cerebellar ataxia, muscle atrophy, contractures and, ultimately, disability can develop. In addition, this condition leads to social maladjustment of the patient. With successful treatment, the prognosis is moderately favorable - it is usually not possible to completely eliminate atactic symptoms, but it is possible to significantly reduce them and maintain the quality of life at an acceptable level.
Video
We offer for viewing a video on the topic of the article.
Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
