Chapter 8: Ataxia and Gait Disorders Flashcards
Which part of neuraxis causes ataxia
Cerebellar or sensory ataxia
Vermis vs. Hemispheric Cerebellar lesions
Vermal lesions: truncal and gait ataxia
Hemispheric lesions: Ipsilateral limb ataxia
Cerebellar Hemorrhage/Infarction
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
Alcoholic Cerebellar Degeneration
Damages the vermis (truncal and gait ataxia)
Most common cause of acquired cerebellar degeneration.
Accompanied commonly by alcoholic polyneuropathy
Postinfectious Cerebellitis
Children age 2-7
Follows VZV or other virus
Limb, gait ataxia and dysarthria
Complete recovery
Paraneoplastic Cerebellar Degeneration
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
Friedreich Ataxia
Aut. rec.
Progressive ataxia arms>legs, severe dysarthria
Childhood onset
Loss of reflexes, spasticity and extensor plantar responses, impaired vibration and position sense
Intention tremor
Rhythmic side-to-side oscillations of the limb as it approaches the target
Dysdiadochokinesia
Abnormality of rapid alternating movement (RAM)
Gait ataxia
Broad-based and unsteady
Dysarthria
Slow scanning and monotonous speech
Scanning speech
Pausing in between syllables of words, putting unusual emphasis or force on syllables
Drugs that cause ataxia
Phenytoin, barbiturates, antineoplastic agets
Inherited Episodic Ataxia
Brief episodes of ataxia, vertigo, nausea, and vomiting
Autosomal Dominant Spinocerebellar Degenerations
Cerebellar ataxia with or without additional neurologic signs.
Insidious onset
Miller Fisher Syndrome
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
Cerebellar Stroke
Sudden onset of cerebellar ataxia, vomiting, depressed consciousness
Common cause of ataxia in children
Postinfectious cerebellitis
Small cell lung cancer or gynecologic malignancy and ataxia
Paraneoplastic cerebellar degeneration
Hemiparetic gait
Stiff leg and toes scrape the floor
Paraparetic
Bilateral hemiparesis, adductor tone increased and legs cross with walking (scissoring gait)
Akinetic-Rigid Gait
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
Frontal Gait
Flexed posture
Small, shuffling, and hesitant steps
Magnetic: difficulty lifting feet off the ground
Hydrocephalus, tumor, stroke, neurodegeneration
Waddling gait
hip-girdle weakness, abductor muscle weakness (glutes)
Trendelenberg gait
Muscular dystrophy, spinal muscular atrophy, acquired proximal myopathy
Sensory ataxia
Slapping gait
Loss of proprioceptive input from the feet
Cautious, wide based, slow steps
Large-fiber neuropathy: B12 deficiency
Dorsal columns: Tabes dorsalis
Psychogenic gait
There is good strength and postural reflexes, so they lurch without falling
Hemiparetic gait
Hemispheric dysfunction, most likely from a stroke
Paraparetic gait
Spinal cord disease
Multiple sclerosis, transverse myelitis, compressive myelopathy.
May be diffuse anoxic injury to the brain
Hydrocephalus (including NPH), neurodegenerative process, or bifrontal or diffuse subcortical disease
Frontal gait
Ophthalmoplegia
Also known as ophthalmoparesis
Weakness/paralysis of one or more extraocular muscles
