Ataxia
Ataxia is a violation of coordination of movements that is not caused by muscle weakness. At the same time, the patient is able to make movements, but their coordination is observed. The result is a violation of most body functions — movement, speech, walking, swallowing, fine motor skills. Ataxia is not considered an independent disease, but rather a secondary one, since it develops against the background of diseases of the nervous system.
The content of the article:
Classification of ataxias
Symptoms of ataxia
Diagnosis of ataxia
Complications of ataxia
Treatment of ataxia
Prognosis for ataxia
Prevention of ataxia
Ataxia
Classification of ataxias
Doctors classify ataxia depending on which area of the brain was affected. There are four forms of the disease in total.
When the vestibular apparatus is affected, vestibular ataxia is diagnosed.
Patients with lesions of the frontal or high-occipital region are diagnosed with cortical ataxia.
Cerebellar ataxia is detected in patients with cerebellar lesion.
Sensitive — in case of violation of the conductors of deep muscle sensitivity.
Symptoms of ataxia
Sensitive ataxia
In most cases, this pathology occurs due to damage to the posterior pillars, posterior nerves, peripheral nodes, the visual hillock, the cortex of the parietal lobe of the brain. Signs of sensitive ataxia can be observed both in all limbs at once, and only in one of them. Doctors often diagnose signs of ataxia, which occurs due to a disorder of the articular-muscular feeling in the legs.
The characteristic signs of ataxia will be the instability of the patient, excessive bending of his legs in the knee and hip joints. Many patients often have the feeling that they are walking on cotton wool or carpet. Patients try to compensate for walking disorders with the help of vision, as they begin to constantly look at their feet. Due to severe damage to the posterior columns, patients almost completely stop walking.
Cerebellar ataxia
It occurs due to a serious lesion of the cerebellar worm, as well as its legs and hemispheres. However, it is worth noting that cerebellar ataxia can be a symptom of diseases such as multiple sclerosis, encephalitis, malignant neoplasm in the cerebellum or brain stem. Patients with this pathology usually fall in the direction of the damaged hemispheres of the cerebellum when walking. During such episodes, even falls are possible.
The patient usually staggers a lot when walking, and also puts his legs too wide, his movements are slow, sweeping and awkward. Coordination disorders practically do not change even with vision control. Patients may experience serious speech disorders, which gradually slows down, becomes chanted and stretched. There are also problems with handwriting, which becomes uneven and sweeping.
Vestibular ataxia
This pathology occurs due to damage to the vestibular nerve, labyrinth, cortical center and nuclei in the brain stem. This type of ataxia is observed in various ear diseases, stem encephalitis, Meniere’s syndrome, tumors of the IV ventricle of the brain. The main sign of pathology is considered to be regular severe dizziness, as a result of which the patient begins to feel that all objects are moving in the same direction. Turning his head, the patient feels increased dizziness.
Severe dizziness leads to unsteady gait and falls. It is also noticeable that the patient tries to make very careful movements with his head. Vestibular ataxia is also characterized by symptoms such as vomiting, nausea and horizontal nystagmus.
Cortical ataxia
Cortical ataxia in most cases occurs due to damage to the frontal lobe of the brain. The most common causes of it include tumors, circulatory disorders in the brain, abscesses. In the case of this type of ataxia, symptoms such as instability when walking, falling over or leaning to the side are manifested.
Due to severe damage to the frontal lobe, patients may lose the ability to walk and stand. Cortical ataxia is also characterized by other symptoms: a change in the psyche, a grasping reflex, a violation of the sense of smell. In many ways, the clinical picture of cortical ataxia is similar to the symptoms of cerebellar pathology.
Cerebellar Pierre-Marie ataxia
The main manifestation of the disease is cerebellar ataxia. The disease occurs due to cerebellar hypoplasia, atrophy of the bridge of the brain and the lower olives. Usually, the first signs of pathology appear in a patient at the age of 35 years.
The most characteristic symptoms of the disease are considered to be a violation of gait, speech and facial expressions. In addition, patients usually have dysmetria, static ataxia, adiadochokinesis, increased tendon reflexes, decreased strength in the muscles of the extremities. Oculomotor disorders are often diagnosed in patients:
lack of inertia;
ptosis;
paresis of the abductor nerve;
Argyle-Robertson symptom;
decreased visual acuity;
narrowing of the visual fields;
atrophy of the optic nerves.
Ataxia-telangiectasia
This type of ataxia is also hereditary and is transmitted by an autosomal recessive type. Often, the first symptoms of pathology appear at a very early age. The disease progresses very quickly, so at the age of 10, the child almost completely loses the ability to walk independently. Pathology can be accompanied by damage to the cranial nerves and mental fatigue.
Friedreich ‘s familial ataxia
This disease is hereditary and occurs due to damage to the spinal systems. As a result of research, it was found that many patients with this type of ataxia often have blood marriages in their pedigree. The main symptom of ataxia is considered to be an uncertain and awkward gait.
The gradual development of the disease leads to impaired hand movements, problems with facial expressions, speech retardation, hearing loss. Further development of ataxia leads to skeletal changes, cardiac arrhythmias, endocrine disorders, frequent dislocations, kyphoscoliosis.
Diagnosis of ataxia
Diagnosis of the disease begins with the collection of complaints and anamnesis. Namely, the doctor necessarily clarifies from the patient how long ago he had complaints about unsteadiness of gait and impaired coordination of movements, how often and regularly these symptoms manifest themselves. It is definitely worth checking with the patient whether his relatives were ill with this disease. It is also necessary to find out whether the patient has taken any medications such as benzodiazepines and barbiturates.
Patients who have a suspicion of ataxia need a neurological examination. This examination involves an assessment of the coordination of movements and gait, an assessment of strength in the limbs and muscle tone, the presence of nystagmus, strength in the limbs.
For a correct assessment of hearing, an otolaryngologist’s examination will also be required.
Laboratory tests
Laboratory tests are of great importance in the diagnosis of ataxia.
Namely, to study the signs of poisoning, which could cause a violation of coordination, a toxicological analysis is prescribed.
A blood test is required, since ataxia may cause signs of inflammation in the blood and an increase in the level of white blood cells.
The concentration of vitamin B12 in the blood is also being determined.
Additional analyses
For a more detailed study of the disease, a consultation with a neurosurgeon will be required, as well as a number of instrumental studies.
In particular, a lot of information about the disease can be obtained using electroencephalography. This technique evaluates the electrical activity of various parts of the brain, which tends to change in various diseases.
CT and MR of the brain are also equally effective methods. They allow you to study the structure of the brain in layers, detect a violation of the structure of its tissues, identify ulcers, tumors, hemorrhages.
Magnetic resonance angiography will detect tumors in the brain and assess the integrity of the arteries in the skull.
Complications of ataxia
Treatment of ataxia should be timely, as otherwise serious complications are possible. One of the most dangerous complications of ataxia is considered to be heart failure. This is an acute or chronic condition that is accompanied by shortness of breath, swelling, and frequent fatigue. The danger of pathology is that it can cause pulmonary edema. To date, heart failure is one of the most common causes of death. No less dangerous complications of ataxia are also repeated infectious diseases and respiratory failure.
Treatment of ataxia
Treatment of ataxia is aimed at eliminating the etiological factor that provoked the development. Depending on the specific disease, the following operations may be prescribed:
removal of the tumor;
elimination of hemorrhage;
removal of the abscess and subsequent antibacterial therapy.
In rare cases, a procedure to reduce pressure in the posterior cranial fossa may be necessary. Namely, this procedure is carried out in case of detection of an Arnold-Chiari anomaly in a patient, which is characterized by a slight omission of a part of the cerebellum into the opening of the skull, which eventually leads to severe compression of the brain stem. The cause of ataxia can also be hydrocephalus, which is characterized by the accumulation of cerebrospinal fluid in the ventricular system of the brain. In this case, doctors create an outflow of cerebrospinal fluid, due to which the metabolism in the brain is normalized.
If the cause of this serious disease is high blood pressure, it is necessary to normalize it with the help of drug therapy. If there is a violation of blood circulation in the brain, drugs that improve metabolism and blood flow are also shown. These primarily include nootropics and angioprotectors.
Ear diseases can also lead to the development of ataxia. In the case of an infectious brain lesion caused by ear pathology, a course of antibiotic therapy is prescribed. If there is a lack of vitamin B12, it must be compensated. To eliminate poisoning, vitamins of group A, B, and C. With demyelinating diseases, the appointment of hormonal drugs, as well as plasmapheresis, is indicated. This procedure involves the removal of blood plasma, but at the same time the preservation of blood cells.
Ataxia is a dangerous disease, because due to a violation of coordination, serious injuries can occur in the patient. You can prevent this if you follow a few rules:
All patients, regardless of the stage of their disease, it is better to give up driving a car and working with power tools. In these situations, a lack of coordination can cause serious injury.
Patients with ataxia should always keep the room well lightened to increase the depth of perception and avoid injury. Twilight is especially dangerous for patients.
Many patients experience serious difficulties with climbing the stairs. To avoid injury, it is necessary to hold onto the railing or use outside help while climbing the stairs.
If it is very difficult for a patient to move independently due to a violation of coordination, he should use a walker or a cane while moving.
In case of nausea or severe dizziness, you should immediately sit down or lie down.
Doctors also advise you to listen to your body. Therefore, if the disease worsens, it is worth making an appointment with a neurologist.
Prognosis for ataxia
As for hereditary diseases, their prognosis is unfavorable, since many patients, in addition to serious movement disorders, gradually progress neuropsychiatric disorders. In addition, their ability to work is significantly reduced. It is possible to improve the prognosis for patients with the help of symptomatic treatment of the disease, as well as the prevention of injuries and infectious diseases. To avoid hereditary ataxia, it is necessary to exclude any possibility of related marriages.
Prevention of ataxia
To prevent the disease, doctors advise to lead an active lifestyle. Namely, it is worth walking in the fresh air every day, observing the correct sleep and wakefulness regime, adhering to the principles of healthy eating, and exercising. It is advisable to treat all infectious diseases in a timely manner, as well as constantly monitor blood pressure.
