Cerebellar ataxia
Cerebellar ataxia is a neurological disorder that manifests itself as a violation of coordination of movements due to damage to the cerebellum and its connections. The symptoms of pathology include specific disorders of gait and balance, problems with smoothness of speech, muscle hypotension, discoordination of movements, dizziness. Treatment is selected depending on the disease that provoked the condition.
The content of the article:
Causes of cerebellar ataxia
Symptoms of cerebellar ataxia
Diagnosis of cerebellar ataxia
Treatment of cerebellar ataxia
Prognosis and prevention
Cerebellar ataxia
The cerebellum is the part of the brain that is located right at its base. This organ consists of two hemispheres, which are responsible for the accuracy of movements. The hemispheres of the cerebellum are separated by a worm, which provides balance and stability when walking. Depending on which part of the cerebellum was affected, there are two forms of pathology: static-locomotor (worm lesion, in which there is a disorder of stability and gait) and dynamic (hemispheres are affected, which is why the ability to perform arbitrary movements of the limbs is impaired).
Causes of cerebellar ataxia
In neurology, the classification of cerebellar ataxia is used, based on the criteria of the course of the disease. There are three main types of ataxia: acute, subacute and chronic. Each of these types can be caused by various diseases.
Ataxia with acute onset (develops suddenly after exposure to provoking factors on the body):
ischemic stroke caused by atherosclerotic occlusion or embolism of the cerebral arteries that feed the cerebellar tissues (considered one of the most common causes of pathology);
hemorrhagic stroke;
injury of the cerebellum, which appeared due to its intracerebral hematoma or traumatic brain injury;
multiple sclerosis;
Guillain-Barre syndrome;
encephalitis and postinfectious cerebellitis;
intoxication of the body (lithium, barbiturates, diphenine);
hyperthermia;
metabolic disorders;
obstructive hydrocephalus.
Ataxia with subacute onset (develops within one or several weeks):
tumors, various types of abscesses and other volumetric processes in the cerebellum (astrocytoma, medulloblastoma, hemangioblastoma, ependymoma);
normotensive hydrocephalus provoked by subarachnoid hemorrhage after brain surgery or meningitis;
endocrine disorders (hyperparathyroidism, hypothyroidism);
vitamin deficiency;
overdose of anticonvulsants;
toxic and metabolic disorders associated with absorption and nutrition disorders;
malignant tumor diseases (lung cancer, ovarian cancer);
paraneoplastic cerebellar degeneration.
Chronically progressive ataxia (develops within a couple of months or years):
spinocerebellar ataxia (Friedreich’s ataxia, “Non-Friedreich’s” ataxia);
cortical cerebellar ataxia (Cortical atrophy of the Holmes cerebellum, Late cerebellar atrophy of Marie-Foix-Alajouanin);
cerebellar ataxia with late onset (OCA, Machado-Joseph disease, cerebellar dysgenesis).
Symptoms of cerebellar ataxia
Patients with cerebellar ataxia usually make sweeping and uncertain movements while walking. Their gait is shaky, for greater stability they try to spread their legs wide. If the patient is asked to try to walk along one line, you will notice how he swings from one side to the other. Usually, the symptoms of the disease become more pronounced when the patient suddenly changes the direction of movement or gets up from a chair and tries to walk quickly immediately.
When walking, the following conditions are observed: hypometry (sudden stop of movement even before a certain goal has been achieved) and hypermetria (excessive amplitude of movements). Patients with cerebellar ataxia are usually not able to perform opposite movements quickly. Due to problems with coordination, a pathological change in handwriting occurs: a macrography appears, it becomes sweeping and uneven.
The pathology of the cerebellum is also characterized by a deviation when walking or even falling in one direction. During the appointment with a neurologist, the patient performs a finger-nasal test. Usually, patients have not only waving a finger past the tip of the nose, but also a noticeable tremor of the hands. At the same time, it does not matter at all whether the patient’s eyes are open or closed, since this does not affect the results of the test. With the help of this test, it is possible to distinguish cerebellar ataxia from vestibular and sensitive.
The following symptoms are characteristic of congenital types of cerebellar ataxia:
violation of the coordination of individual muscles;
vertical instability;
abruptness of speech;
delayed speech and mental development;
later, the beginning of walking and sitting and in babies.
Cerebellar ataxia is often accompanied by dysarthria and nystagmus. It is impossible not to notice that the patient has problems with speech: it slows down, loses its smoothness, becomes intermittent and chanted. As the disease progresses, patients’ handwriting is impaired, facial expressions become impoverished, lower back pain appears, convulsive twitching occurs, vision worsens, strabismus develops, difficulties with swallowing and eating in general arise, hearing is impaired, the psyche changes and depression occurs.
A characteristic sign of the disease, thanks to which it is possible to diagnose it, will be a violation of combined movements, which normally should go together. For example, during the deviation of the trunk back, a person usually bends his legs at the knees, and when trying to look up, throwing his head back, slightly wrinkles his forehead. In patients with ataxia, these movements are usually not coordinated.
Diagnosis of cerebellar ataxia
When diagnosing, the doctor must necessarily take into account that it can be caused by a variety of diseases. That is why specialists such as a neurologist, traumatologist, oncologist, endocrinologist, geneticist, and neurosurgeon participate in the diagnosis of pathology. The first stage of diagnosis is the examination of the patient and the collection of anamnesis. Patients with impaired coordination, as a rule, complain of staggering and falling while walking.
To make an accurate diagnosis, the doctor asks the patient about whether the symptoms of pathology are increasing in the dark, he is interested in whether he is disturbed by frequent dizziness. During the clinical examination, the neurologist evaluates the patient’s walking and balance. For example, in order to check walking, the doctor may ask the patient to walk in a straight line, then make a turn.
CT, MSCT and MRI of the brain are considered the most reliable methods of making an accurate diagnosis in cerebellar ataxia. With their help, it is possible to detect brain tumors, congenital anomalies, pathological changes in the cerebellum. For a more accurate diagnosis of pathology, Dopplerography and MRA of brain vessels can also be used. Genetic analysis and DNA diagnostics allow to identify the disease in the case of its hereditary etiology.
The symptoms of cerebellar ataxia are in many ways similar to the symptoms of other neurological pathologies. Therefore, it is important for a neurologist to conduct the most accurate differential diagnosis. Namely, with the help of studies of the vestibular analyzer (vestibulometry, stabilography, electronistagmography), it is possible to exclude vestibular disorders. It is possible to detect cerebrospinal hypertension, hemorrhage symptoms, tumor or inflammatory processes by performing a lumbar puncture. It is possible to exclude an infectious brain lesion by obtaining the results of a PCR study or a blood test for sterility.
Treatment of cerebellar ataxia
Treatment of cerebellar ataxia is aimed at eliminating the disease that provoked it. In any case, how to treat cerebellar ataxia will be decided by a group of doctors who are competent in this area, taking into account the patient’s condition and his chances of recovery.
Drug therapy
If the pathology was caused by an infectious and inflammatory process, in this case the doctor prescribes antiviral or antibacterial therapy. Vascular disorders that have caused cerebellar ataxia are treated by stopping cerebral bleeding or normalizing blood circulation. To do this, the patient is prescribed the following groups of drugs: thrombolytics, angioprotectors, antiplatelet agents, anticoagulants, vasodilators.
If cerebellar ataxia has a hereditary etiology, it is impossible to completely get rid of it. Basically, doctors resort to metabolic therapy, which provides for the appointment of drugs such as cerebrolysin, vitamins B12, B6 and B1, ATP, ginkgo biloba, mildronate, piracetam. To increase the tone of skeletal muscles and improve metabolism in it, massage is recommended for patients.
Surgical therapy
The most difficult and long-term treatment will be ataxia caused by a tumor disease. In this case, doctors resort to radical surgical treatment. If during the diagnosis of the tumor its malignant nature is revealed, doctors additionally prescribe a course of chemotherapy. To eliminate cerebellar ataxia provoked by hydrocephalus, bypass surgery is prescribed.
Conservative therapy
In addition to drug therapy and surgical operations, complex therapy of the disease provides for the appointment of other conservative methods. According to the indications, speech therapy classes, occupational therapy, physiotherapy, physical therapy can be prescribed to patients. The latter involves both performing sports exercises and repeatedly repeating various household skills to improve coordination of movements: turning pages, pouring liquids, buttoning clothes.
Prognosis and prevention
The prognosis for the patient depends solely on the cause that provoked the onset of the disease. Acute and subacute ataxias caused by intoxication of the body, vascular disorders, and inflammatory processes can completely regress or partially persist. In this case, the prognosis for the patient will be as favorable as possible if the provoking factor can be eliminated in time: infection, toxic effects, vascular occlusion.
The chronic form of ataxia is characterized by a gradual increase in symptoms, which eventually leads to disability of the patient. The greatest danger to the patient’s life is represented by cerebellar ataxia caused by tumor processes. The rapid development of the disease and disruption of the functioning of many organs leads to serious complications that significantly worsen the quality of life of the patient.
Prevention of cerebellar ataxia provides for the prevention of traumatic brain injuries, infection of the body, the development of vascular disorders, timely treatment of chronic cerebral ischemia, compensation for metabolic and endocrine disorders, mandatory genetic counseling during pregnancy planning.
