Ataxia and Gait Disturbances

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Ataxia and Gait Disturbances

• Dr. Tallam
• Prepared by T. Gifford

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Ataxia and Gait Disturbances

• Usually a symptom not a diagnosis.
• Ataxia failure to produce smooth intentional
  movements
• Gait disorders deviation from the normal gait.
• Include ataxic gait as well as others
• Cerebellar lesions are NOT the most common cause
  of these problems.

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Pathophysiology

• Systemic
• Intoxicants
• Alcohol
• Sedatives hypnotics
• Anti-seizure meds
• Heavy metals
• Metabolic disorders
• Hyponatremia
• Inborn errors of metab.

• Nervous System
• Cerebellum
• Bleed, infarct, degeneration, abscess
• Cortex
• Frontal tumor, bleed, trauma, hydrocephalus
• Subcortical
• Thalamic bleed / infarct
• Parkinsons
• Spinal Cord
• Cervical spondylosis
• Posterior column disorders

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Pathophysiology

• Motor (cereballar) ataxia
• Cerebellar problem
• Midcerebellum
• Axial muscles
• Posture
• Lateral cerebellum
• Motor ataxia of ipsilateral limb
• Integration of proprioception faulty

• Sensory ataxia
• Failure of proprioception transmission to the CNS
• Peripheral nerves, spinal cord, cerebellar input
  tracts
• May be partially compensated by conscious visual
  sensory input

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Clinical

• History
• H/A, N/V, fever, meds
• Symptom history
• Severity
• Onset
• Acute vs chronic?
• Severity and progression

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Clinical Exam

• Orthostatic vitals
• Gait testing
• Normal walk
• Walk on heels
• Walk on toes
• Tandem gait
• Posture

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Clinical Exam

• Cerebellar testing
• Rapid movements
• Dyssynergia
• Breakdown of movements into parts
• Dysdiadochokinesia
• Clumsy movements
• Dysmetria
• Inaccurate movements

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Clinical Exam

• Romberg
• Primarily test of sensation
• Eyes closed and ataxia
• Sensory ataxia or peripheral neuropathy
• Ataxic but no change with eyes closed
• Motor ataxia possible at cerebellum

• Other
• Neurosyphilis (tabes dorsalis)
• Sensory ataxia
• Slow, wide gait and stares at ground for visual
  cues
• Cannot walk in dark

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Clinical Exam

• Other
• Nystagmus
• Suggests intercranial problem not peripheral or
  spinal cord

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Clinical Exam

• Ataxic gait types
• Motor ataxic or cebellar
• Wide based
• Irregular, unsteady
• Sensory ataxia
• Abrupt movement
• Slapping impact of feet
• Apraxic
• Difficult initiating step
• Frontal lobe or NPH

• Equine (high stepping)
• Foot drop from peroneal weakness
• Requires high step to clear foot
• Festinating
• Narrow based
• Miniature shuffling steps
• Parkinsons

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Clinical Exam

• Ataxic gait types
• Helicopod
• Leg swings out
• Mild hemiparesis
• Unilateral proximal leg weakness
• Waddling
• Bilateral proximal leg weakness

• Functional
• All pathways working properly but patient unable
  to walk normally
• Usually conversion disorder
• Wild gaits
• Dramatic form called astasia-abasia

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Diagnosis

• Determine
• sensory vs motor
• Systemic or neurological
• If neurological
• Peripheral or CNS
• Tempo of illness

• Acute onset / rapidly progression warrant
  aggressive work up.
• Outpatient evaluation may be suitable for chronic
  or slowly progressing disturbances.