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Neuro Ataxia and Gait

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erichf's version from 2012-08-22 15:05

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Question Answer
Def Ataxiafailure to make smooth, intentional movements
Ingestions causing ataxia with preserved alertnessphenytoin, carbamazepine, valproic acid, heavy metals—lead, organic mercurials
Metabolic disorders causing gait disturbance/ataxiahyponatremia, inborn error of metabolism, wernicke’s encephalopathy
Cortex lesions causing primarily gait disturbancefrontal lesion, hydrocephalus
Subcortical lesions causing primarily gait disturbancethalamic infarction/hemorrage, Parkinson's Disease, Normal Pressure Hydrocephalus
Spinal cord lesions causing primarily gait disturbancecervical spondylosis, posterior column disorders
Peripheral nervous system disorders causing primarily gait disturbanceperipheral neuropathy, vestibulopathy
Usual brain lesion location of motor ataxiasusually cerebellum, but can be internal capsule or frontal lobe
Usual causes of sensory ataxiasdisorders of afferent pathways: peripheral nerves, spinal cord, cerebellar input
What manoever can bring out a sensory ataxia on examclose the eyes
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Question Answer
Dyssynergia isbreakdown of movements into parts
Dysmetria isinaccurate fine movements
Dysdiadochokinesiaclumsy rapid movements
What are signs of lateral cerebellar dysfunctiondyssynergia, dysmetria, dysdiadochokinesia
F-N with eyes closed testsarm poprioception
Describe Rhomberg testFirst: stand with arms outstretched, eyes open, feet close together. Second: close eyes to see if ataxia worsens
What does Rhomberg testeyes open part tests for general ataxia, eyes closed: if ataxia worsens, problem is afferent (proprioceptive or peripheral neuropathy)
What does “Rhomberg positive” meanataxia worsens when eyes are closed
Possible causes of posterior column diseaseneurosyphilis, B12 deficiency
What signals travel in the posterior columnsafferent vibration/proprioception
Gait of sensory ataxiaabrupt mvt of legs and slapping of feet with each step; much worse in the dark
Apraxic gaitlose the ability to initiate walking
DDx apraxic gaitnondominant hemisphere lesion, frontal lobe dysfunction, normal pressure hydrocephalus
Festinating gaitnarrow-based shuffling becoming more rapid (Parkinson’s)
Cause of gait with outward swinging of legsmild hemiparesis with proximal muscle weakness
What accompanies the gait disturbance of Wernicke’sconfusion or eye movement abN
What infections can cause gait disturbance in childrenvaricella, coxsackievirus A/B, mycoplasma, echovirus, postinfections inflammation, postimmunization
Cause of acute cerebellar ataxia of childhoodpost-infectious demyelinating disorder
Characteristics of acute cerebellar ataxia of childhood2d-2wks after febrile illness, abrupt-onset ataxia, +/- dysmetria
w/u for post-infections ataxianone if varicella, otherwise: MRI, LP, consult
Causes of ataxia specific to children1. Acute cerebellar ataxia of childhood, 2. Transverse myelitis, 3. Inherited metabolic disorders
Describe opsoclonus-myoclonus and causerapid chaotic eye movements with myoclonic jerks of head and extremities; usually paraneoplastic
Normal pressure hydrocephalus on CTventriculomegaly out of proportion to increased size of sulci
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