Ataxia

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[[Category:Ataxias]]{{SubjectBox|Ataxia}} Movement disorder of coordination. Classically ataxia is thought of as caused by disease of the [[cerebellum]] or cerebellar pathways. As with most neurology matters can be slightly more complex than this. A wide variety of specific ataxias exist, with a wide variety of patholophysiological causation. Ataxia is also a more general symptom of poisonings and other disease processes. See [[:Category:Ataxias]]. Common situations are the presentation of an acute ataxia in someone previously moving normally, and the investigation of an ataxia which has developed chronically. The history and neurological and locomotor examinations are clearly important and may help prioritise investigations. Always be aware of toxins such as [[alcohol]] as a cause and the easily treatable acute presentations such as severe [[hypoglycaemia]]. ==History== *Family history *Toxin exposure and drugs **[[Alcohol]] - chronic exposure **[[Phenytoin]] - chronic exposure **Anti-epileptics/neuromodulating drugs even at therapeutic doses, eg [[Valproic acid]], [[Pregabalin]], [[Topiramate]]. **[[Carbon monoxide]], [[Carbon disulphide]], [[Petrol sniffing]], [[Lead]], [[Mercury]] ([[Minamata disease]]), [[Paradichlorobenzene]] (mothballs), [[Methyl bromide]] **[[Ciguatera poisoning]] *Age of onset *Rate of progression *Wide systems review (for example malignancy (can be paraneoplastic), [[coeliac disease]], [[vasculitis]] or [[syphilis]] could each present with a patient complaint of ataxia]] ==Examination== *General examination including full neurological examination *Evidence for cerebellar localisation **Lateralised or isolated truncal ataxia suggesting focal cerebellar pathology **[[Dysdiadochokinesis]] **[[Dysmetria]] **[[Nystagmus]] **[[Intention tremor]] with gross over shoot **Cerebellar dysarthria **[[Hypotonia]] **[[Rombergism]] == Investigation of ataxia == *Non specific screening tests of which the most important in the acute setting is [[glucose]] *Vitamin B12 and folate *Thyroid function tests *CXR *MRI brain Consider: **[[Ceruloplasmin]] ([[Wilson's disease]] presentaton) **[[Ferritin]] ([[haemochromatosis]] presentation) **Autoantibodies ***anti-Purkinje ***anti- neuronal nuclear ***anti-GAD ***anti-gliadin antibodies (possibily an association with a number of neurological conditions)<ref>[http://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=17175889 Lock RJ, Tengah DP, Williams AJ, Ward JJ, Bingley PJ, Wills AJ, Unsworth DJ. Cerebellar ataxia, peripheral neuropathy, "gluten sensitivity" and anti-neuronal autoantibodies. Clinical laboratory. 2006; 52(11-12):589-92.]</ref> {{refsec}} {{draft}}

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