STUDY - Technical - New Dacian's Medicine
Ataxia
(Classical / Allopathic Medicine)
Classified as
cerebellar or sensory, ataxia refers to incoordination and
irregularity of voluntary, purposeful movements. Cerebellar
ataxia results from disease of the cerebellum and its pathways
to and from the cerebral cortex, brain stem, and spinal cord.
It causes gait, trunk, limb and, possibly, speech disorders.
Sensory ataxia, which can cause gait disorders, typically
results from impaired position sense (proprioception) due to
interruption of afferent nerve fibers in the peripheral
nerves, posterior roots, posterior columns of the spinal cord,
or medial lemnisci. It may also be caused by a lesion in
either parietal lobe.
Ataxia occurs in
acute and chronic forms. Acute ataxia may result from stroke,
hemorrhage, or a large tumor in the posterior fossa. With this
life-threatening condition, the cerebellum may herniate
downward through the foramen magnum behind the cervical spinal
cord or upward through the tentorium on the cerebral
hemispheres. Herniation may also compress the brain stem.
Acute ataxia may also result from drug toxicity or poisoning.
Chronic ataxia can be progressive and, at times, can result
from acute disease. It can also occur in metabolic and chronic
degenerative neurologic disease.
ALERT:
If the patient suddenly develops ataxic movements:
- examine him for signs of increased intracranial pressure and impending herniation
- determine his level of consciousness, and be alert for pupillary changes, motor weakness or paralysis, neck stiffness or pain, and vomiting
- check his vital signs (Make sure emergency resuscitation equipment is readily available.)
- prepare him for computed tomography scanning or surgery.
If the patient's condition permits, perform a focused assessment.
If the patient suddenly develops ataxic movements:
- examine him for signs of increased intracranial pressure and impending herniation
- determine his level of consciousness, and be alert for pupillary changes, motor weakness or paralysis, neck stiffness or pain, and vomiting
- check his vital signs (Make sure emergency resuscitation equipment is readily available.)
- prepare him for computed tomography scanning or surgery.
If the patient's condition permits, perform a focused assessment.
HISTORY:
Review the patient's medical history for multiple sclerosis, diabetes, central nervous system infection, neoplastic disease, and previous stroke.
Ask the patient about a family history of ataxia.
Ask the patient about chronic alcohol abuse or prolonged exposure to industrial toxins such as mercury.
If the patient has gait ataxia, ask if he tends to fall to one side or if falling is more common at night.
If the patient has truncal ataxia, remember that his inability to walk or stand, combined with the absence of other signs while he's lying down, may give the impression of hysteria or drug or alcohol intoxication.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Review the patient's medical history for multiple sclerosis, diabetes, central nervous system infection, neoplastic disease, and previous stroke.
Ask the patient about a family history of ataxia.
Ask the patient about chronic alcohol abuse or prolonged exposure to industrial toxins such as mercury.
If the patient has gait ataxia, ask if he tends to fall to one side or if falling is more common at night.
If the patient has truncal ataxia, remember that his inability to walk or stand, combined with the absence of other signs while he's lying down, may give the impression of hysteria or drug or alcohol intoxication.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
Perform Romberg's test to help distinguish between cerebellar and sensory ataxia. Test results may indicate normal posture and balance (minimal swaying), cerebellar ataxia (swaying and inability to maintain balance with eyes open or closed), or sensory ataxia (increased swaying and inability to maintain balance with eyes closed). Stand close to the patient during this test to prevent him from falling.
Perform Romberg's test to help distinguish between cerebellar and sensory ataxia. Test results may indicate normal posture and balance (minimal swaying), cerebellar ataxia (swaying and inability to maintain balance with eyes open or closed), or sensory ataxia (increased swaying and inability to maintain balance with eyes closed). Stand close to the patient during this test to prevent him from falling.
SPECIAL
CONSIDERATIONS:
Toxic levels of an anticonvulsant, especially phenytoin, may result in gait ataxia. Toxic levels of an anticholinergic or a tricyclic antidepressant may also result in ataxia.
Toxic levels of an anticonvulsant, especially phenytoin, may result in gait ataxia. Toxic levels of an anticholinergic or a tricyclic antidepressant may also result in ataxia.
PEDIATRIC
POINTERS:
In children, ataxia occurs in acute and chronic forms and results from congenital or acquired disease. Acute ataxia may stem from febrile infection, a brain tumor, mumps, and other disorders. Chronic ataxia may stem from Gaucher's disease, Refsum's disease, and other inborn errors of metabolism.
When assessing a child for ataxia, consider his motor-skill level and emotional state. Your examination may be limited to observing the child in spontaneous activity and carefully questioning his parents about changes in his motor activity, such as increased unsteadiness or falling. If you suspect ataxia, refer the child for a neurologic evaluation to rule out a brain tumor.
In children, ataxia occurs in acute and chronic forms and results from congenital or acquired disease. Acute ataxia may stem from febrile infection, a brain tumor, mumps, and other disorders. Chronic ataxia may stem from Gaucher's disease, Refsum's disease, and other inborn errors of metabolism.
When assessing a child for ataxia, consider his motor-skill level and emotional state. Your examination may be limited to observing the child in spontaneous activity and carefully questioning his parents about changes in his motor activity, such as increased unsteadiness or falling. If you suspect ataxia, refer the child for a neurologic evaluation to rule out a brain tumor.
PATIENT
COUNSELING:
Help the patient adapt to his condition. Promote rehabilitation goals and help ensure the patient's safety. Ask the patient's family to check the home for hazards, such as uneven surfaces or the absence of handrails on stairs. If appropriate, refer the patient with progressive disease for counseling.
Help the patient adapt to his condition. Promote rehabilitation goals and help ensure the patient's safety. Ask the patient's family to check the home for hazards, such as uneven surfaces or the absence of handrails on stairs. If appropriate, refer the patient with progressive disease for counseling.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)