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An introduction to Clinical Neurology by Alan Guberman, M.D.

Ataxia and Cerebellar Disorders

Ataxia, which is an incoordination of movement, may affect gait, or it may involve the limbs individually, together, or bilaterally, the lower extremities only, or various combinations of the proceeding.

Disturbances of proprioception (sensory ataxia), vestibular input, and weakness may also produce ataxia.

The cerebellum is concerned with regulating the timing, coordination, and integration of movements, including extraocular movements and speech. It functions closely with the motor cortex, basal ganglia, vestibular system and spinal motor system.

Causes of Recurrent Falling Attacks without Apparent Loss of Consciousness

Other Causes of Progressive or Chronic Ataxia

Click to enlargeA type II Chiari or Arnold Chiari malformation includes distortion and anomalous development of the cerebellum, but usually patients are seen because of signs of hydrocephalus or spasticity, rather than because of ataxia. Midline subarchnoid cysts may occur in the posterior fossa, usually in association with a hydroplastic cerebellar vermis. The cysts may or may not be communicating with the fourth ventricle. They may be asymptomatic, give rise to intermittent or progressive symptoms of raised intracranial pressure due to hydrocephalus, or be manifested by symptoms of gait ataxia, which may be intermittent.

Diagnosis is readily accomplished by CT or MRI scanning, and the communications with the fourth ventricle can be ascertained by intrathecal radionuclide injection and posterior fossa scanning.

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