ATAXIA Dr. Shamekh M. El-Shamy

THE CEREBELLUM ANATOMY: the cerebellum is formed of 2 main parts: ANATOMY: the cerebellum is formed of 2 main parts: 1. A midline central structure, known as the vermis. 1. A midline central structure, known as the vermis. 2. Two lateral cerebellar hemispheres. *cerebellum can be divided: 1- Focculo-nodular lobe.2. Anterior lobe. 3- Posterior lobe. 2. Two lateral cerebellar hemispheres. *cerebellum can be divided: 1- Focculo-nodular lobe.2. Anterior lobe. 3- Posterior lobe.

Anterior lobe Posterior lobe Foocculo-nodular lobe Paleocerebellum Neocerebellum Archicerebellum

Archicerebellunm (flocculo-nodular lobe): Archicerebellunm (flocculo-nodular lobe):

Paleo-cerehellum (anterior lobe): Paleo-cerehellum (anterior lobe):

Neocerebellum (posterior lobe): Neocerebellum (posterior lobe):

Blood Supply The cerebellum is supplied by : The cerebellum is supplied by : Superior cerebellar artery (branch of the basilar artery). Superior cerebellar artery (branch of the basilar artery). Anterior inferior cerebellar artery (branch of the basilar artery). Anterior inferior cerebellar artery (branch of the basilar artery). Posterior inferior cerebellar artery (branch of the vertebral artery). Posterior inferior cerebellar artery (branch of the vertebral artery).

Cerebellum Syndromes I.Archicerebellar syndrome: I.Archicerebellar syndrome:

II.Neo-cerebellar syndrome: II.Neo-cerebellar syndrome: There is incoordination of voluntary motor activities There is incoordination of voluntary motor activities

ATAXIA Definition: Incoordination of voluntary motor activity with or without disequilibration in the absence of motor weakness. Definition: Incoordination of voluntary motor activity with or without disequilibration in the absence of motor weakness.

Cerebellum Ataxia Causes of Cerebellar Ataxia: Causes of Cerebellar Ataxia: I.Herido-familial: I.Herido-familial: 1. Friedreich's ataxia. 2. Marie's ataxia. 1. Friedreich's ataxia. 2. Marie's ataxia. II. Symptomatic : II. Symptomatic : Congenital Congenital Infective Infective Vascular Vascular Toxic Toxic

5. Neoplastic 5. Neoplastic 6. Demyelination 6. Demyelination 7. Metabolic 7. Metabolic III. Idiopathic:

Clinical picture of Cerebellar Ataxia I. Incoordination of movements of different muscles in the form of: a)Nystagmus in the eyes. a)Nystagmus in the eyes. b) Staccato speech. c) Nodding of the head. d) Titubaiion of the trunk. d) Titubaiion of the trunk. e) Kinetic tremors of the limbs. e) Kinetic tremors of the limbs.

II. Hypotonia and hyporeflexia of the affected muscles. III. Gait disturbance: Wide base or drunken gait in archicerebellar lesions. IV. Positive tests: used by the neurologist to detect cerebellar ataxia.

TESTS OF CEREBELLAR ATAXIA 1. Finger to nose test:

2. Finger to doctor's finger test: you may found you may found a) Decomposition of movement. a) Decomposition of movement. b) Kinetic intention tremors b) Kinetic intention tremors c) Dysmetria in the form of hypermetria or hypometria c) Dysmetria in the form of hypermetria or hypometria

3. Adiadokokinesis

4. Rebound phenomenon:

5. Heel to knee test

HERIPO-FAMILIAL ATAXIAS I. Friedreich's Ataxia 1. It occurs in the 1st decade of life. 2. Gradual onset and slowly progressive course. 3. Positive family history is common as it is inherited as an autosomal recessive disease.

4. Pathologically there is degeneration of: - Cerebellum specially the archicercbcllum & the spinocerebellar tracts. - Pyramidal tracts. - Posterior columns. - Peripheral nerves. P.N

II. Marie's Ataxia 1. It occurs in the 2nd and 3rd decades of life. 2. Gradual onset and slowly progressive course. 3. Pathologically there is degeneration of: 3. Pathologically there is degeneration of: - Cerebellum specially the neo-cerebellum (dentate nucleus) - Cerebellum specially the neo-cerebellum (dentate nucleus) -Pyramidal tracts. -Pyramidal tracts.

- It presents with progressive manifestations of neocerebellar degeneration. - Mental impairment, ocular nerve paralysis and extrapyramidal syndromes are occasionally present.

SENSORY ATAXIA SENSORY ATAXIA Definition:- It is ataxia due to loss of the proprioceptive (deep) sensations, at any point in their pathway. Definition:- It is ataxia due to loss of the proprioceptive (deep) sensations, at any point in their pathway.

Causes :- Causes :- 4. Medial lemniscus : brain stem lesions. 5. Thalamus : thalamic syndrome. 6. Cortical sensory area : parietal lobe lesions.

Rhomberg’s Test : Rhomberg’s Test :

VESTIBULAR ATAXIA Definition :- It is ataxia due to lesions of the vestibular division of the eighth nerve. Definition :- It is ataxia due to lesions of the vestibular division of the eighth nerve.

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