Ataxia differential diagnosis: Difference between revisions

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*Related to M. pneumonia, Epstein-Barr virus, herpes simplex virus, and toxoplasmosis
*Related to M. pneumonia, Epstein-Barr virus, herpes simplex virus, and toxoplasmosis
|Subacute ataxia which progress in months
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* Positive serologic test for HIV
* Cerebellar atrophy
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*Toxicology testing
*Toxicology testing
*Elevated plasma levels of substances like lithium, and phenytoin
*Other imaging unremarkable; Cerebellar atrophy in late stages
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*Progressive and multifocal
*Progressive and multifocal
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* Magnetic resonance imaging (MRI) reveals a multifocal process limited to the white matter
*Magnetic resonance imaging (MRI) reveals a multifocal process limited to the white matter
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*Caused by reactivation of the JC virus in immunocompromised hosts.
*Caused by reactivation of the JC virus in immunocompromised hosts.

Revision as of 16:29, 24 August 2020

TYPE CAUSE PROGRESSION IMAGING FEATURES and OTHER TESTS ASSOCIATED FACTORS SYMPTOMS
Acute cerebellitis
  • Primary infectious, postinfectious or postvaccination disorder.
  • Epstein-Barr virus, influenza A and B, mumps, varicella-zoster virus, coxsackie virus, rotavirus, echovirus, Mycoplasma pneumoniae and immunization
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
  • 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.
  • Trunk and limbs ataxia, fever, abnormal eye movements, dysarthria, headache, nausea, vomiting and decreased level of consciousness
Bacterial infection
  • Mycoplasma pneumoniae, Listeria monocytogenes
  • 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
  • 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
  • Progressive and multifocal
  • Magnetic resonance imaging (MRI) reveals a multifocal process limited to the white matter
  • Caused by reactivation of the JC virus in immunocompromised hosts.
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.
  • Symptoms and signs of tumor local invasion,
  • Adjacent structures compression,
  • Raised intracranial pressure
Stroke
Vestibular neuritis

References


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