Chapter 8: Ataxia and Gait Disorders

Question 1

Which part of neuraxis causes ataxia

Answer 1

Cerebellar or sensory ataxia

Question 2

Vermis vs. Hemispheric Cerebellar lesions

Answer 2

Vermal lesions: truncal and gait ataxia

Hemispheric lesions: Ipsilateral limb ataxia

Question 3

Cerebellar Hemorrhage/Infarction

Answer 3

Abrupt onset of vertigo, vomiting, and inability to walk.
Level of arousal may be depressed if their is compression of fourth ventricle with hydrocephalus
Need neurosurgical decompression

Question 4

Alcoholic Cerebellar Degeneration

Answer 4

Damages the vermis (truncal and gait ataxia)
Most common cause of acquired cerebellar degeneration.
Accompanied commonly by alcoholic polyneuropathy

Question 5

Postinfectious Cerebellitis

Answer 5

Children age 2-7
Follows VZV or other virus
Limb, gait ataxia and dysarthria
Complete recovery

Question 6

Paraneoplastic Cerebellar Degeneration

Answer 6

Pancerebellar syndrome: Truncal, gait, and limb ataxia; dysarthria; ocular motility issues (ocular dysmetria, nystagmus)
Acute/Subacute and then stabilizes with profound disability
Associated with Gynecologic or small cell lung cancer
CSF: elevated protein or lymphocytic pleocytosis
Anti-Yo, anti-Hu antibodies

Question 7

Friedreich Ataxia

Answer 7

Aut. rec.
Progressive ataxia arms>legs, severe dysarthria
Childhood onset
Loss of reflexes, spasticity and extensor plantar responses, impaired vibration and position sense

Question 8

Intention tremor

Answer 8

Rhythmic side-to-side oscillations of the limb as it approaches the target

Question 9

Dysdiadochokinesia

Answer 9

Abnormality of rapid alternating movement (RAM)

Question 10

Gait ataxia

Answer 10

Broad-based and unsteady

Question 11

Dysarthria

Answer 11

Slow scanning and monotonous speech

Question 12

Scanning speech

Answer 12

Pausing in between syllables of words, putting unusual emphasis or force on syllables

Question 13

Drugs that cause ataxia

Answer 13

Phenytoin, barbiturates, antineoplastic agets

Question 14

Inherited Episodic Ataxia

Answer 14

Brief episodes of ataxia, vertigo, nausea, and vomiting

Question 15

Autosomal Dominant Spinocerebellar Degenerations

Answer 15

Cerebellar ataxia with or without additional neurologic signs.
Insidious onset

Question 16

Miller Fisher Syndrome

Answer 16

Triad of ataxia, areflexia, and ophthalmoplegia.
Due to proprioceptive loss rather than to cerebellar dysfunction.
Variant of Guillain Barre, due to a postinfectious immune process most likely.
IgG anti-GQ1b
Good prognosis

Question 17

Cerebellar Stroke

Answer 17

Sudden onset of cerebellar ataxia, vomiting, depressed consciousness

Question 18

Common cause of ataxia in children

Answer 18

Postinfectious cerebellitis

Question 19

Small cell lung cancer or gynecologic malignancy and ataxia

Answer 19

Paraneoplastic cerebellar degeneration

Question 20

Hemiparetic gait

Answer 20

Stiff leg and toes scrape the floor

Question 21

Paraparetic

Answer 21

Bilateral hemiparesis, adductor tone increased and legs cross with walking (scissoring gait)

Question 22

Akinetic-Rigid Gait

Answer 22

Parkinsonian gait. Shuffling, slow with short steps and reduced arm swing.
Progressive supranuclear palsy is that the posture tends toward extension rather than flexion.
Basal ganglia

Question 23

Frontal Gait

Answer 23

Flexed posture
Small, shuffling, and hesitant steps
Magnetic: difficulty lifting feet off the ground

Hydrocephalus, tumor, stroke, neurodegeneration

Question 24

Waddling gait

Answer 24

hip-girdle weakness, abductor muscle weakness (glutes)
Trendelenberg gait

Muscular dystrophy, spinal muscular atrophy, acquired proximal myopathy

Question 25

Sensory ataxia

Answer 25

Slapping gait
Loss of proprioceptive input from the feet
Cautious, wide based, slow steps

Large-fiber neuropathy: B12 deficiency
Dorsal columns: Tabes dorsalis

Question 26

Psychogenic gait

Answer 26

There is good strength and postural reflexes, so they lurch without falling

Question 27

Hemiparetic gait

Answer 27

Hemispheric dysfunction, most likely from a stroke

Question 28

Paraparetic gait

Answer 28

Spinal cord disease
Multiple sclerosis, transverse myelitis, compressive myelopathy.

May be diffuse anoxic injury to the brain

Question 29

Hydrocephalus (including NPH), neurodegenerative process, or bifrontal or diffuse subcortical disease

Answer 29

Frontal gait

Question 30

Ophthalmoplegia

Answer 30

Also known as ophthalmoparesis

Weakness/paralysis of one or more extraocular muscles