Causes of Ataxia/ Gait disturbance

Question 1

Systemic

Answer 1

Intoxication
- reduced alertness (ETOH, Sedatives)
Intoxication
- without reduced alertness (phenytoin, carbamezapine, valproate, heavy metals)
Metabolic
- hyponatremia, inborn errors of metabolism, wernickes

Question 2

Primary Nervous system: Central

Answer 2

Cerebellar
- CVA, degenerative, abscess, tumour, post viral
Cortical
- tumour, hemorrhage, trauma, hydrocephalus
Subcortical
- thalamic CVA, parkinsons, normal pressure hydrocephalus
Spinal
- cervical spondylosis, posterior column disorders

Question 3

Primary nervous system: Peripheral

Answer 3

• Peripheral neuropathy: B12 deficiency, diabetic,

- vestibulopathy

Question 4

Ataxia Motor: Cerebellar

Answer 4

loss of integration of proprioceptive info.
Lateral lesion:
- motor ataxia ipsilat limb
- wide based gait
- unsteady irregular gait, difficulty turning avoiding obstacles

Vermis Lesions

• axial muscle incoordination
• truncal ataxia

Romberg negative

Question 5

Ataxia Sensory: Peripheral nervous system

Answer 5

problem with peripheral nerves
dorsal columns or cerebellar input tracts that prevent afferent position sense/ proprioceptive infor reaching cerebellum
Causes:
- abrupt movement of legs with foot slapping impact with ground

Romberg Positive

Question 6

Types of gait

Answer 6

Ataxia
Antalgic ( trauma/ OA/ pelvic girdle pain)
Cerebellar disease
Parkinsonism (flexed festinating gait)
Hemiparesis
Neuropathies (DM, Alcohol, HIV, toxin, Metabolic, Vit def, adverse effects certain drugs)
Paraparesis
Scissor gait
Vestibular disorders

Question 7

Gait Ataxia in children: drug intoxication

Answer 7

ethanol
isopropyl alcohol
phenytoin
carbamazepine
sedative
lead, mercury

Question 8

Gait ataxia in children: idiopathic

Answer 8

acute cerebellar ataxia of childhood

Question 9

Gait ataxia in children: infection & Inflammation

Answer 9

varicella
coxackievirus A & B
mycoplasma
echovirus
post infectious inflammation
post immunisation

Question 10

Gait ataxia in children: neoplasm

Answer 10

neuroblastoma

other CNS tumours

Question 11

Gait ataxia in children: Paraneoplastic

Answer 11

Opsoclonus- myoclonus syndrome
Opsoclonus= rapid chaotic eye movements

post viral or
paraneoplastic: associated with neuroblastoma in abdomen or chest

Question 12

Gait ataxia in children: Trauma

Answer 12

posterior fossa

Subdural or extradural hemorrhage

Question 13

Gait ataxia in children: Hereditary

Answer 13

pyruvate decarboxyalse deficiency
friedreichs ataxia
hartnup disease

Question 14

Gait ataxia in children: Other

Answer 14

hydrocephalus
cerebellar abscess
labyrinthitis/ vestibular neuronitis
transverse myelitis
meningoenchephalitis