Cerebellar ataxy — the koordinatorny violation of motility caused by cerebellum pathology. Its main manifestations include disorder of gait, disproportion and an asinergiya of movements, , change of handwriting as a wide makrografiya. Usually cerebellar ataxy is followed by the chanted speech, intentsionny trembling, a posturalny tremor of the head and trunk, muscular hypotonia. Diagnostics is performed with application of MPT, KT, MCKT, the MAGICIAN of a brain, doppler sonography, the analysis of tserebrospinalny liquid; if necessary — genetic researches. Treatment and the forecast depend on the causal disease which caused development of cerebellar symptomatology.
The cerebellar ataxy represents the simptomokompleks including specific violations of static and dynamic motility of the person and being patognomonichny for any diseases of a cerebellum. The same disorders of coordination of movements arise both at congenital defects of a cerebellum, and at the most various pathological processes in a cerebellum: tumors, multiple sclerosis, strokes, inflammatory and degenerate changes, toxic or metabolic defeat, sdavleniye from the outside and so forth. Degree of their expressiveness considerably varies depending on localization and the sizes of the struck area of a cerebellum.
About the nature of a disease it is possible to judge by the symptoms accompanying an ataxy, and also features of emergence and the course of pathological changes. The last was the basis for classification which is used in the practice by many experts in the field of neurology. According to it the cerebellar ataxy with the sharp beginning, with the subsharp beginning (from 7 days to several weeks), chronically progressing (developing for several months or years) is allocated and incidental (paroksizmalny).
Causes of a cerebellar ataxy
The ischemic stroke caused by an embolism or atherosclerotic occlusion of the cerebral arteries feeding including and cerebellum tissues is the most frequent reason of a sharp ataxy of cerebellar type. Also hemorrhagic stroke, traumatic injury of a cerebellum as a result of ChMT or its sdavleniye the formed intracerebral hematoma is possible. The sharp cerebellar ataxy can develop at multiple sclerosis, Giyen's syndrome, post-infectious tserebellita and encephalitis, obstructive hydrocephaly, various sharp intoxications and metabolic violations.
The subsharp cerebellar ataxy most often arises as a symptom of the intracerebral tumor (an astrotsitoma, a gemangioblastoma, a medulloblastoma, an ependimoma) which is settling down in a cerebellum or meningioma of a mosto-cerebellar corner. Normotenzivny hydrocephaly owing to subarakhnoidalny hemorrhage, the postponed meningitis or brain operation can be its cause. The cerebellar ataxy with the subsharp beginning is possible at overdose of antikonvulsant, a vitamin deficiency, endocrine frustration (a giperparatireoza, a hypothyroidism). She can also act as a paraneoplastic syndrome at malignant tumoral processes of extra cerebral localization (for example, lung cancer, ovarian cancer, nekhodzhkinsky lymphoma and so forth).
Chronically progressing cerebellar ataxy often is a consequence of alcoholism, etc. chronic intoxications (including toxicomanias and polydrug addiction), slowly growing tumors of a cerebellum, genetically caused cerebral degenerate and atrophic processes with defeat of tissues of cerebellum or its carrying-out ways, a severe form of anomaly of Kiari. Among genetically determined progressing ataxy of cerebellar type Fridreykh's ataxy, a nefridreykhovsky spinotserebellyarny ataxy, Pierre-Mari's ataxy, an atrophy of a cerebellum of Holmes, an olivopontotserebellyarny degeneration (OPTsD) are most known.
The cerebellar ataxy with a paroksizmalny current can be hereditary and acquired. Among the reasons of the last specify TIA, multiple sclerosis, intermittiruyushchy obstruction of likvorny ways, a passing compression in the field of an occipital opening.
Symptoms of a cerebellar ataxy
The ataxy of cerebellar type is shown by the wide uncertain asinergichny movements and characteristic shaky gait during which the patient for bigger stability widely places legs. In attempt to pass across one line considerable rocking in the parties is observed. Atactic frustration accrue at sharp change of the direction of the movement or quick start of walking after a rising from a chair. The wide movements are a consequence of violation of their harmony (dismetriya). It is possible as an involuntary stop of the motive act earlier, than the objectives (gipometriya), and excessive amplitude of movements are achieved it (gipermetriya). It is observed — inability of the patient to expedite opposite motive acts (for example, a supination and the pro-nation). Owing to violations of coordination and a dismetriya there is a handwriting change, patognomonichny for an ataxy of cerebellar type: makrografiya, unevenness and boldness.
The static ataxy is most evident in attempt of the patient to strike an attitude Romberg. The deviation, and even falling, towards defeat is typical for pathology of a hemisphere of a cerebellum, at changes in its median structures (worm) falling is possible in any party or back. Carrying out a finger - nasal test reveals not only a promakhivaniye, but also the intentsionny tremor accompanying an ataxy — the trembling of a finger-tip amplifying at its approach to a nose. Testing of the patient in a pose Romberg with the opened and closed eyes, shows that visual control not especially influences results of conducting tests. This feature of a cerebellar ataxy helps to otdifferentsirovat it from a sensitive and vestibular ataxy at which lack of visual control leads to considerable aggravation an incoordination.
As a rule, the cerebellar ataxy is followed nistagmy and a dizartriya. The speech has specific "cerebellar" character: it loses the smoothness, is slowed down and becomes faltering, accents go on each syllable why the speech reminds a chant. Often the ataxy of cerebellar type is observed against the background of muscular hypotonia and decrease in deep reflexes. When calling tendinous reflexes the pendulum movements of an extremity are possible. In certain cases there is a titubation — a low-frequency posturalny tremor of a trunk and head.
Diagnostics of a cerebellar ataxy
As pathology of a cerebellum can have the most various etiology, experts of various directions are involved in its diagnostics: traumatologists, neurosurgeons, oncologists, geneticists, endocrinologists. The careful research of the neurologic status conducted by the neurologist gives the chance to define not only cerebellar character of an ataxy, but also approximate area of defeat. So, the gemiataksiya, the unilateral nature of disorders of coordination and decrease in a muscular tone testifies to pathology in a hemisphere of a cerebellum; about pathological process in a worm of a cerebellum — prevalence of violations of walking and balance, their combination to a cerebellar dizartriya and nistagmy.
For the purpose of an exception of vestibular frustration the research of the vestibular analyzer is conducted: stabilografiya, vestibulometriya, elektronistagmografiya. At suspicion on infectious damage of a brain do blood test on sterility, conduct PTsR-researches. The Lyumbalny puncture with a research of the received tserebrospinalny liquid allows to reveal symptoms of hemorrhage, intra cranial hypertensia, inflammatory or tumoral processes.
Neurovisualization methods act as the main ways of diagnosis of the diseases which are the cornerstone of cerebellum pathology: KT, MSKT and MRT of a brain. They allow to find cerebellum tumors, post-traumatic hematomas, congenital anomalies and degenerate changes of a cerebellum, its prolapse in a big occipital opening and a sdavleniye at the shift of the next anatomic educations. In diagnostics of an ataxy of the vascular nature MRA and doppler sonography of vessels of a brain is applied.
The hereditary cerebellar ataxy is established by results of DNA diagnostics and the genetic analysis. Also the risk of the birth of the child with pathology in a family where cases of this disease were noted can be counted.
Treatment of a cerebellar ataxy
Treatment of a causal disease is fundamental. If the cerebellar ataxy has infectious and inflammatory genesis, purpose of antibacterial or antiviral therapy is necessary. If the reason is covered in vascular disorders, then the events directed to normalization of blood circulation or a stop of cerebral bleeding are held. For this purpose according to indications apply vasoprotectives, trombolitik, antiagregant, vasodilating, anticoagulants. At an ataxy of a toxic origin desintoxication is made: intensive infusional therapy in combination with purpose of diuretics; in hard cases — haemo sorption.
Ataxy of hereditary character has no radical treatment yet. Generally metabolic therapy is performed: B12, B6 and B1 vitamins, ATP, meldony, medicines biloba, piracetam, etc. For improvement of a metabolism in skeletal muscles, increase in its tone and force massage is recommended to patients.
Tumors of a cerebellum and back cranial pole often demand surgical treatment. Removal of a tumor has to be as much as possible radical. At establishment of malignant nature of a tumor in addition appoint a course himio-or roentgenotherapeutic treatment. The shunting operations are applied to the cerebellar ataxy caused by occlusion of likvorny ways and hydrocephaly.
Forecast and prevention
The forecast entirely depends on the reason of a cerebellar ataxy. The sharp and subsharp ataxy caused by vascular disorders, intoxication, inflammatory processes at timely elimination of a causal factor (occlusion of a vessel, toxic influence, an infection) and adequate treatment can regress or partially remain completely in the form of the residual phenomena. Chronically progressing, hereditary ataxy is characterized by the accruing aggravation of the symptomatology leading to the patient's invalidization. The ataxy connected with tumoral processes has the most adverse forecast.
Preventive character has injury prevention, development of vascular disorders (atherosclerosis, a hypertension) and infection; compensation of endocrine and metabolic frustration; genetic consultation when planning pregnancy; timely treatment of pathology of likvorny system, chronic ischemia of a brain, Kiari's syndrome, processes of a back cranial pole.