ATAXIA

The coordination of movements is

regulated by the following
systems:

cerebellum and its pathways

vestibular system
deep sensory pathways
frontal lobes and their pathways
 Types of ataxia

Cerebellar
Vestibular
Sensory
Frontal
HYSTERICAL
CEREBELLAR
ATAXIA
The anatomy of
cerebellum
 Symptoms of cerebellar
dysfunction

Broad-base (taxic) gait

Broad-base standing

intentional tremor

dysdiadochokinesis

dysmetria

horizontal nystagmus

scanning speech
Reasons of cerebellar ataxia
Vascular disorders: stroke
Neoplastic disorders: tumor of the cerebellum
Metabolic disorders: alcohol abuse,hypoxia,
hypoglycaemia
Demyelinative disorders: multiple sclerosis
Degenerative disorders: spino-cerebellar
ataxias, multi-system atrophy and the other
degenerative disorders
Paraneoplastic syndrome: subacute
cerebellar degeneration
Ischemic stroke in cerebellum
Glioblastoma of the cerebellum
VESTIBULAR
ATAXIA
 VESTIBULAR SYSTEM and its
connections

Temporal lobe

Labirinth, n.vestibulocohlearis, Cerebellum

vestibular nuclei of brainstem

Nuclei of the brainstem Spinal cord

(III, IV and VI nerves)
Symptoms of vestibular
ataxia

Vertigo
Unsteadiness of gait
Nystagmus
Nausea, vomiting
 Peripheral vertigo

Localization of lesion: labyrinth,

vestibular nerve
Common causes:

Benign posional paroxismal vertigo

Meniere syndrome

Vestibular neuronitis
 Central vertigo

Localization of lesion: brain stem

Common causes:
Stroke
Brain tumor
Multiple sclerosis
Infection
Basilar migraine
 Differentiation between
peripheral and central vertigo
Symptoms Peripheral vertigo Central vertigo

Nystagmus Horizontal or horizontal- Often vertical or

rotary, transient, rotary, persistent,
suppressed by visual may increase by
fixation or with closed visual fixation or with
eyes closed eyes
Vomiting, nausea + -
Hearing loss -/+ -
The direction of To the side of lesion Variable
fall
Sign of pons - +
lesion
entral nystagmus

Rotary,
persistent,
may increase
by visual
fixation
 Benign paroxysmal
positional vertigo (BPPV)
recurrent momentary episodes of
vertigo.
vertigo is rotatory directed to
unaffected labyrinthine with a
tendency to fall towards the affected
labirinthine
Horizontal nystagmus to unaffected
labirinthine
Dix-Halpike maneuver

Ethiology:canalolithiasis (the presence

of detached otoliths, floating in the
posterior semicircular canal, which
irritate vestibular receptors.
 Dix-Halpike maneuver

the patient is rapidly taken from

a sitting to a supine position while the head is kept turning 45 to one side.
If nystagmus and vertigo ensue, they are due to canalolithiasis of the side
of the ear nearer the ground
Dix-Halpike maneu
SENSORY
ATAXIA
 The common causes of sensory
ataxia
Vitamin B12
deficiency
Polyneuropathies
Neurosyphilis
Stroke in spinal cord
Tumor of the spinal
cord
Symptoms of sensory
ataxia

Unsteadiness of gait, which increases

with closed eyes and in the darkness
Positive Romberg test with closed eyes
Decreased deep sensation
feet usually stamp on the ground
Pseudoatetosis
Secondary astereognosis
FRONTAL
ATAXIA
 FRONTAL ATAXIA
is characterized by a wide base,
short steps, shuffling,
hesitation in starting to walk
and in turning, and moderate
disequilibrium.
Associated findings: dementia,
pseudobulbar pulsy, dysarthria,
sins of frontal release,
paratonia, pyramidal syndrome
and urinary disturbances
 FRONTAL ATAXIA

Common causes
Multi-infarct dementia
Normal pressure
hydrocephalus
Tumor