What are the types of ataxia?
Coordination is ensured by the joint work of the cerebellum, deep sensory pathways and the vestibular apparatus. Depending on which link is affected, several types of ataxia are distinguished. With cerebellar, a person staggers and with his eyes open, misses, trembling appears when approaching the target. In sensitive cases, associated with impaired sensitivity, unsteadiness increases sharply in the dark and with eyes closed, and the gait becomes clumsy. Vestibular is accompanied by dizziness and nausea. There is also a frontal form, in which a person has difficulty starting movement.
- Cerebellar - missing and trembling, scanned speech
- Sensitive - worse in the dark, stamping gait
- Vestibular - dizziness, nausea, nystagmus
- Frontal - difficulty starting to walk
- Mixed forms in systemic diseases
Reasons
Acute ataxia is most often associated with a stroke in the cerebellum or brainstem, hemorrhage, poisoning, including alcohol and drugs. Subacute development is characteristic of multiple sclerosis, tumors, inflammatory processes and deficiency of B vitamins. Slowly progressive ataxia makes one think about hereditary forms, chronic alcohol disease, hypothyroidism, and in the elderly - about vascular damage to the brain. Ataxia is separately identified as a side effect of anticonvulsants and some other drugs.
- Stroke and cerebellar hemorrhage
- Multiple sclerosis
- Posterior fossa tumors
- Vitamin B12 and vitamin E deficiency
- Alcohol abuse
- Side effects of drugs
- Hereditary ataxias
- Hypothyroidism
Symptoms
The main manifestation is instability. The gait becomes wide, the person seems to be walking along the deck of a ship, leaning to the side, holding on to the walls. The accuracy of hand movements is impaired: it is difficult to fasten a button, get a spoon into your mouth, or pour water. Speech may become slow and choppy, with words split into syllables. Handwriting often changes. Trembling during purposeful movements, twitching of the eyeballs, and dizziness are often associated. Falls are a common and dangerous complication, especially in the elderly.
- Unsteady gait with legs spread wide apart
- Missing with hand movements
- Changing handwriting
- Abrupt, chanted speech
- Trembling when approaching target
- Dizziness and eye twitching
- Falls
Survey
Using simple tests, a neurologist determines the type of ataxia and the level of damage, which immediately narrows the range of causes. Next, in most cases, magnetic resonance imaging of the brain is needed, and if a sensitive form is suspected, a spinal examination and electroneuromyography are needed. Laboratory testing includes vitamin B12, thyroid function tests, glucose, liver function tests, and inflammatory markers. If a hereditary form is suspected, especially in familial cases and in slow progression, genetic testing is discussed.
- Neurological examination with coordination tests
- MRI of the brain
- MRI of the spine for sensitive ataxia
- Electroneuromyography
- Vitamin B12, TSH, glucose, liver function tests
- Review of medications taken
- Genetic testing according to indications
What can you do
First of all, they treat the cause: they replenish the deficiency of vitamins, correct the functioning of the thyroid gland, cancel or replace the drug that caused the disorder, prescribe therapy for multiple sclerosis, and remove the tumor. In case of irreversible forms, rehabilitation becomes the basis: special exercises for balance and coordination really improve stability and reduce the risk of falls. Home safety, selection of a cane or walker, and comfortable shoes are important. Avoiding alcohol is mandatory because it itself damages the cerebellum.
- Treatment of the underlying disease
- Replenishment of vitamin B12 deficiency
- Correction of thyroid function
- Discontinuation or replacement of the drug that caused ataxia
- Balance and coordination exercises
- Cane or walker, safety shoes
- Elimination of thresholds, carpets and poor lighting in the home
- Complete abstinence from alcohol