ATAXIA

Ataxia - coordination of movements, usually caused by a violation of walking and balance (static), but not associated with paralysis.

There are sensitive, vestibular, cerebellar, and psychogenic frontal ataxia. Sensory ataxia is caused by lesions of the deep sensitivity of the fibers carrying information about the position of the body in space and the features of the plane on which there is a person. This variant of ataxia may be associated with neuropathy (eg, diphtheria), spinal cord diseases affecting its rear pillars, in which the fibers deep sensitivity back to the brain (eg, multiple sclerosis, vascular or tumoral diseases) or a combination of these two disorders types (for example, vitamin B12 deficiency). Distinguishing features sensory ataxia: worsening walk in the darkness, revealing violations during the inspection of deep sensitivity (joint and muscle sense, vibration sensitivity), a significant deterioration of the balance in the Romberg position on closing the eyes, decrease or loss of tendon reflexes. A patient with sensory ataxia is carefully trying to control impaired every step and feeling under foot "cotton pillow" high leg raises and lowers its strength throughout the floor sole ( "Legally gait").

Vestibular ataxia is usually accompanied by loss of vestibular apparatus of the inner ear or vestibular nerve (peripheral vestibulopathy), less stem vestibular structures (see. Dizziness). It is usually accompanied by rotational dizziness, lightheadedness, nausea or vomiting, nystagmus, sometimes hearing loss. ataxia Intensity increases at a certain position of the head and torso when the eye is rotated. Patients Avoid sudden head movements and gently change the position of the body. In some cases, there is a tendency to fall toward the affected labyrinth. Coordination in the hands not broken.

Cerebellar ataxia occurs in lesions of the cerebellum or its connections. The patient stands and walks, legs wide apart and swaying from side to side and front to back. Eliminating the visual control (closing the eyes) had little effect on the severity of koordinatornyh disorders. Mild cerebellar ataxia can be identified by asking the patient to follow the same line, the charge of the heel to the toe of one another (tandem walking). In the middle part of the electoral involvement of the cerebellum in isolation violated statics and walking, with the involvement of the cerebral hemispheres develop gemiataksiya on the affected side, which manifests itself a violation of the accuracy of movements and intentsionnogo (arising in the final stages of purposeful movements), tremor, which was detected by the paltsenosovoy and kolennopyatochnoy samples.

The cause of acute cerebellar ataxia may be drug intoxication (drugs lithium, phenytoin, barbiturates, carbamazepine, ethosuximide, benzodiazepines), stroke , viral encephalitis , abscess of the cerebellum. Subacute cerebellar ataxia develops when Gaye -Vernike encephalopathy, ophthalmoplegia and manifested as impaired consciousness and related deficiency of vitamin B1, (alcoholism, inadequate parenteral nutrition, uncontrollable vomiting), mercury poisoning, organic solvents, synthetic glue, gasoline or cytostatics, multiple sclerosis , subdural hematoma. The cause of chronic progressive cerebellar ataxia may be paraneoplastic cerebellar degeneration (remote effect of lung cancer, breast, ovarian), hypothyroidism , alcoholic cerebellar degeneration, tumors of the posterior cranial fossa, Arnold-Chiari malformation (omission of the cerebellar tonsils into the foramen magnum), hereditary cerebellar ataxia .

Hereditary cerebellar ataxia (spinocerebellar degeneration), is divided into autosomal dominant and autosomal recessive. The most common variant of autosomal recessive cerebellar ataxias is Friedreich's ataxia, starting at the age of 8-15 years with unsteadiness when walking and frequent falls. In addition to ataxia, areflexia observed, dysarthria, increased tone in the legs, loss of weight of muscles in distal extremities, scoliosis, foot deformity, cardiomyopathy, diabetes . In autosomal dominant cerebellar ataxia forms often associated with hyperreflexia, tremor and other ekstramidnymi disorders, amyotrophy, ophthalmoplegia, pelvic disorders. When hereditary degenerations spinotsersbsllyarnyh some effect sometimes render amantadine (midantan) and vitamin E. Whatever the reason is important physiotherapy.

The frontal ataxia evident difficulties in the beginning of the movement: the patient for a long time could not move, could hardly separates "magnetized" legs from the floor, making a few "test" small steps, or marking time. Moved, he continues to move in small shuffling steps. In severe cases, because of the imbalance of patients unable to stand or sit without support (astasia-Abaza).

Psychogenic (hysterical) ataxia reflected in the bizarre changes distance, usually not observed in the organic lesions of the nervous system. Patients can walk on a broken line, slide like a skater on a skating rink, cross walking "weaving braids" feet on the type of walk on straightened and divorced legs like stilts.