Morning Report October 26, 2010

Ataxia Disturbance in the smooth, accurate coordination of movements Most commonly unsteady gait Result of cerebellar dysfunction or proprioception

Ataxia Causes Acute Intermittent Chronic Infections Post-infectious Toxins Tumors Trauma Stroke Intermittent Migraine Seizure IEM Benign paroxysmal vertigo Chronic Congenital anomalies Degenerative diseases Hereditary ataxias

Life-threatening Ataxia Uncommon Mass effect Increased ICP Vomiting, HA, papilledema Tumors 45-60% of brain tumors are brainstem or cerebellar May be slowly progressive Early morning HA with N/V Papilledema, focal signs, cranial neuropathies

Life-threatening Ataxia ICH Trauma or vascular malformation Stroke Vertebral or basilar artery disease SCD, Hypercoagulable, Homocystinuria

Life-threatening Ataxia Infection Abscess Otitis, mastoiditis Enchephalitis Brainstem, rare CN changes, seizures, AMS ADEM Uncommon Inflammatory demyelinating disease following infection

Acute Ataxia Acute Cerebellar Ataxia Self-limited Post-infectious 2-5 years old Diagnosis of exclusion

Acute Ataxia Guillain-Barre Syndrome Acute inflammatory demyelinating Post-infectious immune response 15% lose sensory input to cerebellum Miller Fisher variant Ataxia, areflexia and opththalmoplegia

Acute Ataxia Labyrinthitis Inflammation of vestibular apparatus Viral or bacterial infection Signs and Symptoms Hearing loss Vomiting Intense vertigo

Acute Ataxia Toxic Exposure 30% ingestion Other symptoms AMS, lethargy, confusion, inappropriate speech or behavior Associated meds Anticonvulsants, lead, CO, inhalants, alcohol, benzos, other drugs of abuse

Acute Ataxia Migraine Trauma Basilar or familial hemiplegic migraines Episodic Trauma Mild traumatic brain injury

Acute Ataxia Other Causes Tick paralysis Hypoglycemia Seizures Conversion disorder IEM Congenital anomalies Degenerative Genetic

History Onset Associated symptoms Access to medications Hx of trauma Fever, HA, N/V Weakness Access to medications Hx of trauma Recent infection or vaccination Previous episodes Family History

Physical Exam Physical findings pertinent to suspected diagnosis Neuro Papilledema Mental status Cranial nerves Motor Sensory Reflexes Cerebellar Gait, speech, coordination

Evaluation and Treatment Tox screen Blood glucose Metabolic eval CSF Infection Neuroimaging MRI preferred Treat underlying cause