Ataxia differential diagnosis: Difference between revisions

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[[Image:Home_logo1.png|right|1x1px|link=https://www.wikidoc.org/index.php/Ataxia]]
[[Image:Home_logo1.png|right|1x1px|link=https://www.wikidoc.org/index.php/Ataxia]]
{| class="wikitable"
{| class="wikitable"
|+
!TYPE
!
!CAUSE
!
!PROGRESSION
!
!IMAGING FEATURES and OTHER TESTS
!
!SYMPTOMS
!
!
!
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|Acute cerebellitis
|'''Acute cerebellitis'''
|
|
*Primary infectious, postinfectious or postvaccination disorder <ref name="pmid30482319">{{cite journal |vauthors=Marsden JF |title=Cerebellar ataxia |journal=Handb Clin Neurol |volume=159 |issue= |pages=261–281 |date=2018 |pmid=30482319 |doi=10.1016/B978-0-444-63916-5.00017-3 |url=}}</ref>.
*Epstein-Barr virus, influenza A and B, mumps, varicella-zoster virus, coxsackie virus, rotavirus, echovirus, ''Mycoplasma pneumoniae'' and immunization
*Postinfectious cerebellitis typically occurs between one and six weeks after varicella or measles, but also can follow Epstein-Barr or other viral infections and vaccinations in teenagers and young adults.
|From self-limited to fatal, depending on the amount of cerebellar swelling
|
|
|More common in children and young adults
*Normal or abnormal brain magnetic resonance imaging (MRI) at onset
|
*Bilateral hemispheric cerebellar swelling with cortical and white matter T2 hyperintensities; leptomenigeal enhancement may be present.
* Normal or abnormal brain magnetic resonance imaging (MRI) at onset
*CSF: Elevated protein and leukocytes, with lymphocytic predominance, normal glucose
|
*Blood/CSF: Antibodies anti- HSV, EBV, VZV, mumps, rubella, Lyme disease
* Epstein-Barr virus, influenza A and B, mumps, varicella-zoster virus, coxsackie virus, rotavirus, echovirus, ''Mycoplasma pneumoniae'' and immunization
|
|
*Trunk and limbs ataxia, fever, abnormal eye movements, dysarthria, headache, nausea, vomiting and decreased level of consciousness
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|Bacterial infection
|'''Bacterial infection'''
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*Mycoplasma pneumoniae, Listeria monocytogenes
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*Usually sudden and progressive
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*Lumbar puncture for examination of the cerebrospinal fluid (CSF) and microbiologic testing
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*Fever
* Mycoplasma pneumoniae, Listeria monocytogenes
*instability when walking
|
*changes in coordination that primarily affect the trunk or head and not the limbs
*nodding or other unusual head movements
*unusual eye movements, such as involuntarily darting from side to side
*slow or slurred speech
*changes in mood, behavior, or personality
*headaches
*nausea or vomiting
|-
|-
|Acquired immunodeficiency syndromes
|'''Acquired immunodeficiency syndromes'''
|
|
|
|
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*Related to M. pneumonia, Epstein-Barr virus, herpes simplex virus, and toxoplasmosis
|Subacute ataxia which progress in months
|
|
* Related to M. pneumonia, Epstein-Barr virus, herpes simplex virus, and toxoplasmosis
*Positive serologic test for HIV
*Cerebellar atrophy
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|-
|-
|Chronic alcohol use/Alcoholic cerebellar degeneration
|'''Chronic alcohol use/Alcoholic cerebellar degeneration'''
|
|
* Toxic effects on the central and peripheral nervous systems
*Toxic effects on the central and peripheral nervous systems


* Direct toxic alcoholic effect on the Purkinje cells
*Direct toxic alcoholic effect on the Purkinje cells
|Rapid progression (weeks or months)
|Rapid progression (weeks or months)
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|
*Vermis atrophy
|
|
* Vermis atrophy
*Severe ataxia of gait and lower limbs with relatively mild involvement of the upper limbs.
|
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* Severe ataxia of gait and lower limbs with relatively mild involvement of the upper limbs.


* Speech and ocular motility are usually preserved
*Speech and ocular motility are usually preserved
|-
|-
|Antibiotic-induced acute ataxia
|'''Antibiotic-induced acute ataxia'''
|
|
* Interaction of polymyxins with neurons has been associated with the occurrence of several neurotoxic events
*Interaction of polymyxins with neurons has been associated with the occurrence of several neurotoxic events
|Weeks after initiation
|Weeks after initiation
|
|
|
*Brain MRI abnormalities
* Brain MRI abnormalities
*Characteristic reversible MRI signal abnormalities in the cerebellar dentate nuclei, dorsal brainstem, or splenium of the corpus callosum
* Characteristic reversible MRI signal abnormalities in the cerebellar dentate nuclei, dorsal brainstem, or splenium of the corpus callosum


* Non-specific EEG abnormalities
*Non-specific EEG abnormalities
|
|
|
*Ataxia may also occur in isolation or combined with dizziness, generalized muscle weakness, partial deafness, visual disturbances, vertigo, confusion, hallucinations, seizures, and neuromuscular blockade
* Ataxia may also occur in isolation or combined with dizziness, generalized muscle weakness, partial deafness, visual disturbances, vertigo, confusion, hallucinations, seizures, and neuromuscular blockade
|-
|-
|'''Toxic ingestions'''
|
|
*Alcohol, benzodiazepines, or other anticonvulsant drugs or exposure to environmental toxins such as mercury or lead
|
|
*Usually sudden and progressive
|
|
*Toxicology testing
*Elevated plasma levels of substances like lithium, and phenytoin
*Other imaging unremarkable; Cerebellar atrophy in late stages
|
|
|
*Additional findings that suggest occult ingestion (eg, depressed consciousness)
|
|
|-
|-
|Para-neoplastic syndrome
|'''Atypical infections'''
|
|
|
|
*Progressive multifocal leukoencephalopathy
*Caused by reactivation of the JC virus in immunocompromised hosts.
|
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*Progressive and multifocal
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|
*Magnetic resonance imaging (MRI) reveals a multifocal process limited to the white matter
|
|
*Presents with subacute neurologic deficits like altered mental status, motor deficits (hemiparesis or monoparesis), limb ataxia, gait ataxia, and visual symptoms such as hemianopia and diplopia
|-
|-
|Vitamin deficiency
|'''Brain tumors'''
|
|
|
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*Nonmalignant and malignant tumors of the brain and spinal cord.
|
|
*Usually progressive over weeks to months
|
|
* MRI
* Biopsy
* Surgery
|
|
*Symptoms and signs of tumor local invasion,
*Adjacent structures compression,
*Raised intracranial pressure
|-
|-
|Chronic infections
|'''Stroke'''
|
|
|
|
|
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|-
|Neurodegenerative diseases
|
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|
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|
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|-
|Brain tumors
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|-
|Stroke
|
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|Vestibular neuritis
|
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|
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*Ischemic stroke (part of the brain loses blood flow)
*Hemorrhagic stroke (bleeding occurs within the brain)
*Risk factors
**high blood pressure (hypertension),
**high cholesterol,
**diabetes, and
**smoking.
|
|
*Progressive or Sudden
|
|
*CT Scan: look for bleeding or masses in the brain.
*CT perfusion scan:  see how much brain is at risk  to check brain blood supply (perfusion).
*MRI of the brain
|Symptoms of ataxia with
*numbness,
*weakness,
*tingling, or
*vision loss or changes.
*Confusion,
*Changes in the level of consciousness,
*Trouble speaking,
*Trouble understanding speech, vertigo,
*Balance problems
|-
|-
|Sjögren syndrome
|'''Vestibular neuritis'''
|
|
|
|
*Problem in the inner ear or the brain.
*Inflammation of the vestibular nerve caused by a virus
|
|
*Symptoms may come and go over short periods of time, or last for longer periods of time
|
|
*Hearing examination,
*Blood tests,
*Electronystagmo-gram
*Imaging studies of the head and brain
|
|
*Dizziness or vertigo
*Falling or a feeling as if you are going to fall
*Lightheadedness, fainting, or a floating sensation
*Blurred vision
*Confusion or disorientation
*Nausea and vomiting
*Diarrhea
*Changes in blood pressure and heart rate
*Fear
*Anxiety
*Panic
|}
|}
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 19:26, 24 August 2020

TYPE CAUSE PROGRESSION IMAGING FEATURES and OTHER TESTS SYMPTOMS
Acute cerebellitis
  • Primary infectious, postinfectious or postvaccination disorder [1].
  • Epstein-Barr virus, influenza A and B, mumps, varicella-zoster virus, coxsackie virus, rotavirus, echovirus, Mycoplasma pneumoniae and immunization
  • Postinfectious cerebellitis typically occurs between one and six weeks after varicella or measles, but also can follow Epstein-Barr or other viral infections and vaccinations in teenagers and young adults.
From self-limited to fatal, depending on the amount of cerebellar swelling
  • Normal or abnormal brain magnetic resonance imaging (MRI) at onset
  • Bilateral hemispheric cerebellar swelling with cortical and white matter T2 hyperintensities; leptomenigeal enhancement may be present.
  • CSF: Elevated protein and leukocytes, with lymphocytic predominance, normal glucose
  • Blood/CSF: Antibodies anti- HSV, EBV, VZV, mumps, rubella, Lyme disease
  • Trunk and limbs ataxia, fever, abnormal eye movements, dysarthria, headache, nausea, vomiting and decreased level of consciousness
Bacterial infection
  • Mycoplasma pneumoniae, Listeria monocytogenes
  • Usually sudden and progressive
  • Lumbar puncture for examination of the cerebrospinal fluid (CSF) and microbiologic testing
  • Fever
  • instability when walking
  • changes in coordination that primarily affect the trunk or head and not the limbs
  • nodding or other unusual head movements
  • unusual eye movements, such as involuntarily darting from side to side
  • slow or slurred speech
  • changes in mood, behavior, or personality
  • headaches
  • nausea or vomiting
Acquired immunodeficiency syndromes
  • Related to M. pneumonia, Epstein-Barr virus, herpes simplex virus, and toxoplasmosis
Subacute ataxia which progress in months
  • Positive serologic test for HIV
  • Cerebellar atrophy
Chronic alcohol use/Alcoholic cerebellar degeneration
  • Toxic effects on the central and peripheral nervous systems
  • Direct toxic alcoholic effect on the Purkinje cells
Rapid progression (weeks or months)
  • Vermis atrophy
  • Severe ataxia of gait and lower limbs with relatively mild involvement of the upper limbs.
  • Speech and ocular motility are usually preserved
Antibiotic-induced acute ataxia
  • Interaction of polymyxins with neurons has been associated with the occurrence of several neurotoxic events
Weeks after initiation
  • Brain MRI abnormalities
  • Characteristic reversible MRI signal abnormalities in the cerebellar dentate nuclei, dorsal brainstem, or splenium of the corpus callosum
  • Non-specific EEG abnormalities
  • Ataxia may also occur in isolation or combined with dizziness, generalized muscle weakness, partial deafness, visual disturbances, vertigo, confusion, hallucinations, seizures, and neuromuscular blockade
Toxic ingestions
  • Alcohol, benzodiazepines, or other anticonvulsant drugs or exposure to environmental toxins such as mercury or lead
  • Usually sudden and progressive
  • Toxicology testing
  • Elevated plasma levels of substances like lithium, and phenytoin
  • Other imaging unremarkable; Cerebellar atrophy in late stages
  • Additional findings that suggest occult ingestion (eg, depressed consciousness)
Atypical infections
  • Progressive multifocal leukoencephalopathy
  • Caused by reactivation of the JC virus in immunocompromised hosts.
  • Progressive and multifocal
  • Magnetic resonance imaging (MRI) reveals a multifocal process limited to the white matter
  • Presents with subacute neurologic deficits like altered mental status, motor deficits (hemiparesis or monoparesis), limb ataxia, gait ataxia, and visual symptoms such as hemianopia and diplopia
Brain tumors
  • Nonmalignant and malignant tumors of the brain and spinal cord.
  • Usually progressive over weeks to months
  • MRI
  • Biopsy
  • Surgery
  • Symptoms and signs of tumor local invasion,
  • Adjacent structures compression,
  • Raised intracranial pressure
Stroke
  • Ischemic stroke (part of the brain loses blood flow)
  • Hemorrhagic stroke (bleeding occurs within the brain)
  • Risk factors
    • high blood pressure (hypertension),
    • high cholesterol,
    • diabetes, and
    • smoking.
  • Progressive or Sudden
  • CT Scan: look for bleeding or masses in the brain.
  • CT perfusion scan: see how much brain is at risk to check brain blood supply (perfusion).
  • MRI of the brain
Symptoms of ataxia with
  • numbness,
  • weakness,
  • tingling, or
  • vision loss or changes.
  • Confusion,
  • Changes in the level of consciousness,
  • Trouble speaking,
  • Trouble understanding speech, vertigo,
  • Balance problems
Vestibular neuritis
  • Problem in the inner ear or the brain.
  • Inflammation of the vestibular nerve caused by a virus
  • Symptoms may come and go over short periods of time, or last for longer periods of time
  • Hearing examination,
  • Blood tests,
  • Electronystagmo-gram
  • Imaging studies of the head and brain
  • Dizziness or vertigo
  • Falling or a feeling as if you are going to fall
  • Lightheadedness, fainting, or a floating sensation
  • Blurred vision
  • Confusion or disorientation
  • Nausea and vomiting
  • Diarrhea
  • Changes in blood pressure and heart rate
  • Fear
  • Anxiety
  • Panic

References

  1. Marsden JF (2018). "Cerebellar ataxia". Handb Clin Neurol. 159: 261–281. doi:10.1016/B978-0-444-63916-5.00017-3. PMID 30482319.


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