Ataxia 2025 PDF

Ataxia Dr / HAMADA ZEHRY Lecturer of Neurology , Horus University  ILOs:- Definition of ataxia Types of ataxia Daignosis of Ataxia Treatment of Ataxia  A) Archicerebellum (Flocculo - nodular lobe): (Oldest part) Maintenance of equilibrium through...

Ataxia Dr / HAMADA ZEHRY Lecturer of Neurology , Horus University  ILOs:- Definition of ataxia Types of ataxia Daignosis of Ataxia Treatment of Ataxia  A) Archicerebellum (Flocculo - nodular lobe): (Oldest part) Maintenance of equilibrium through its connection with vestibular apparatus ( Vestibulocerebellum) B) Pleocerebellum (Anterior lobe): Regulation of muscle tone through its connection with spinal cord (Spinocerebellum) C) Neocerebellum (Posterior lobe): (Recent and largest part) Coordination of distal limb movements and speech Regulation of fine delicate (executive) voluntary movements Organize trunk movements and gait  Definition Literally, Ataxia is derived from Greek word ‘a’ - not ‘taxis’ - orderly ( not orderly/ not in order ) Definition: Incoordination of voluntary motor activity with or without disequilibrium in absence of motor weakness. Not due to : - Motor weakness. - Change in muscle tone. - Involuntary movements. Ataxia is the inability to make smooth, accurate and coordinated movements  “errors in the RATE, RANGE, FORCE & DIRECTION of movement” Ataxia is a symptom, not a specific disease or diagnosis. Ataxia The term ataxia is most often used to describe walking that is uncoordinated and unsteady. Factors concerned in coordination of movements 1- Information from muscles, tendons & joints. 2- Information from the labyrinths. 3- An intact cerebellar system.  A) In the head and neck: Intention kinetic tremors Methods of Head nodding testing coordination Dysarthria Nystagmus  Methods of testing coordination B) In the trunk and limbs : Observe for titubation of the trunk then carry out the following tests: In the upper limbs: 1- Finger to nose test. 2- Finger to finger test. 3- Finger to doctor,s finger test. 4- Dysdiadochokinesis. 5- Rebound. 6- Rapid hand tapping. 7- Tapping in a circle. 8- Drawing a spiral. 9- Past-pointing test  Methods of testing coordination In the lower limbs : 1- Heel to knee test. 2- Rhomberg,s test. 3- Gait.  Types of ataxia 1- Cerebellar ataxia. 2- Sensory ataxia. 3- Mixed ataxia. 4- Vestibular ataxia. 5- Psychogenic ataxia.  Sensory Ataxia Thalamic Ataxia (Posterior Column) Labrynthine Ataxia Cortical Ataxia Cerebellar Ataxia Sensory Ataxia Myopathy (Peripheral Neuropahy))  Etiology : Loss of cerebellar function Site of lesion : 1- 1- The cerebellum : a- Intrinsic lesions Cerebellar b- Compressing lesions Ataxia 2- Cerebellar connections : a- Peduncles b- Tracts  A) Heridofamilial : 1- Friedreich,s ataxia. 2- Marie,s ataxia. B) Symptomatic : 1- Congenital ( Basilar impression – Arnold Chiari ) 2- Infective ( Encephalitis – Abscess – Causes of Tuberculoma ) 3- Vascular ( SCA, MCA & ICA occlusion ) cerebellar 4- Toxic ( Alcohol – barbiturates – Hydantoins ) 5- Neoplastic ( Medulloblastoma – ataxia Astrocytoma ) 6- Demyelinating ( M.S. – D.E.M. ) 7- Metabolic ( Cortical cerebellar degeneration ) C) Idiopathic : Delayed cortical cerebellar degeneration.   Age: 1st decade of life  Onset: Gradual with slow progressive course  Cause: Autosomal recessive hereditary ataxia usually there is family history  Pathogenesis: Degeneration of Friedreich’s Cerebellum (archicerebellum) and spinocerebellar tracts Ataxia Pyramidal tract Posterior column of spinal cord Peripheral nerves  Clinical A) In the head and neck picture of - Head nodding - Staccato speech cerebellar - Nystagmus. ataxia B) In the trunk and limbs - Titubation of the trunk - Kinetic tremors - + ve tests for cerebellar ataxia - Ataxic gait C) Associated manifestations - Hypotonia & hyporeflexia  Peripheral neuropathy All of the Thalamic infarction following can B12 deficiency anaemia cause ataxia Post. Column lesion except ? Non of above 2-Sensory ataxia Etiology : Loss of deep or proprioceptive sensations. Site of lesion & causes : 1- Peripheral nerves ( polyneuropathy ) 2- Posterior roots ( tabes dorsalis ) 3- Posterior column ( B12 deficiency, M.S., heriditary ataxias ) 4- Brain stem ( vascular lesions, tumours ) 5- Thalamus ( vascular lesions ) 6- Thalamo-cortical connections ( vascular lesions ) 7- Sensory cortex ( vascular lesions or tumurs )  A) In the head and neck : No head nodding, nystagmus, or dysartheria. Clinical B) In the trunk and limbs : picture - Kinetic tremors only on closure of the eyes. - Tests of ataxia when the eyes are closed. of - +ve Rhombergism. sensory - Stamping gait. ataxia C) Associated manifestations : - Loss of deep sensations. - Hypotonia & hyporeflexia. 3- Mixed Ataxia Mixed sensory and cerebellar ataxia due to affection of both systems. - M.S. - Heriditary ataxia. 4- Vestibular ataxia Ataxia due to lesions of the labyrinth or vestibular portion of 8th cranial nerve - Meniere,s disease - Labyrinthitis - Acoustic neuroma Associated manifestations - Vertigo, tinnitus & deafness - Vestibular nystagmus - Impaired tests of vestibular functions  5- Psychogenic ataxia Ataxia associated with : - Presence of responsible psychogenic factor. - Absence of signs of organic disease.  Take home messages :- Ataxia usually results from damage to the part of the brain that controls muscle coordination (cerebellum) or its connections. Many conditions can cause ataxia, including alcohol misuse, stroke, tumor, brain degeneration, multiple sclerosis, certain medications and genetic disorders. Treatment for ataxia depends on the cause.  Adams and Victor's Principles of References Neurology Clinical neurology / Lord Brain [email protected] +201091949392 Any Question?