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As ataxias paraneoplásicas são causas comuns de ataxia aguda. Que manifestações clínicas nos levariam a suspeitar de uma afecção desse tipo? Quais são os tumores mais comumente associados à ataxia cerebelar?
«ataxia cerebelar hereditária» introduzido por Pierre Marie e enfatizou a necessidade de classificar as doenças cerebelares primárias com base nos achados patológicos e na respectiva patogenia.
- Infectious Acute Cerebellar Ataxias
- Acute Cerebellar Ataxia Related to Toxic Causes
- Immune-Mediated Causes of Acute Cerebellar Ataxia
- Structural Lesions Causing Acute Cerebellar Ataxia
- Other Causes of Acute Cerebellar Ataxia
- Conclusion
Acute cerebellar ataxias secondary to infectious diseases most commonly involve the posterior fossa. In the pediatric population, the most frequent cause of acute ataxia is cerebellitis33 Javalkar V, Kelley RE, Gonzalez-Toledo E, McGee J, Minagar A. Acute ataxias: differential diagnosis and treatment approach. Neurol Clin. 2014 Nov;32(4):881-91. ht...
Alcoholic cerebellar degeneration
The cerebellum, particularly the Purkinje cells, are susceptible to a large number of toxic agents, alcohol being the most common. Alcohol may cause toxic effects on the central and peripheral nervous systems. Alcoholic cerebellar degeneration is related either to a direct toxic alcoholic effect on the Purkinje cells and vitamin B1 deficiency (see section of vitamin deficiency)88 Nachbauer W, Eigentler A, Boesch S. Acquired ataxias: the clinical spectrum, diagnosis and management. J Neurol. 2...
Antibiotic-induced acute ataxia
Weeks after initiation of metronidazole, an encephalopathy accompanied by cerebellar signs and brain MRI abnormalities may occur. It is characterized by cerebellar dysfunction, rare seizures, and non-specific EEG abnormalities. Metronidazole toxicity results in characteristic reversible MRI signal abnormalities in the cerebellar dentate nuclei, dorsal brainstem, or splenium of the corpus callosum. Both increased and decreased diffusivity have been observed in MRI, suggesting the variable pres...
Other toxic agents causing acute ataxia
Several drugs may cause toxic ataxia, dependent on the dosing and timing of use. The main agents include anticonvulsants (carbamazepine, phenobarbital, vigabatrin, gabapentin, lamotrigine and phenytoin), antineoplastics (5-fluorouracil, cytosine arabinoside, capecitabine, methotrexate), lithium and amiodarone. It is important to mention that interaction between medications can increase the plasmatic level of these agents22 Barsottini OG, Albuquerque MV, Braga-Neto P, Pedroso JL. Adult onset s...
Immune-mediated ataxias may cause acute, subacute or chronic ataxia. In this topic, we will focus on the acute and subacute autoimmune ataxias not related to a demyelinating disease, such as multiple sclerosis.
Primary brain tumors, such as meningiomas and gliomas, as well as metastatic tumors secondary to melanoma, breast and lung cancer, may present with acute ataxia (Figure 5)33 Javalkar V, Kelley RE, Gonzalez-Toledo E, McGee J, Minagar A. Acute ataxias: differential diagnosis and treatment approach. Neurol Clin. 2014 Nov;32(4):881-91. https://doi.org/...
Childhood periodic syndromes
Previously called “childhood periodic syndromes that are commonly precursors of migraine” in the International Classification of Headache Disorders (ICHD)-II or colloquially “childhood periodic syndromes”, these disorders were renamed “episodic syndromes that may be associated with migraine” in the ICHD-III beta. Infant colic affects young babies, benign paroxysmal torticollis older infants, benign paroxysmal vertigo typically affects preschool-aged children, abdominal migraine and cyclical v...
Psychogenic ataxia
Psychogenic movement disorders may present with a broad spectrum of phenomenology that may resemble, but can be differentiated from, organic movement disorders by careful history and examination, sometimes supplemented by ancillary tests4444 Thenganatt MA, Jankovic J. Psychogenic movement disorders. Neurol Clin. 2015 Feb;33(1):205-24. https://doi.org/10.1016/j.ncl.2014.09.013 https://doi.org/10.1016/j.ncl.2014.09.01... . Psychogenic gait disorders may have various clinical presentations, such...
Migraine with brainstem aura and other vestibular disorders
Migraine with brainstem aura, previously named basilar migraine or basilar-type migraine, is a subcategory of migraine with aura. Ataxia is listed among the brainstem symptoms that may occur during an attack, together with dysarthria, vertigo, tinnitus, hypoacusis, diplopia and decreased level of consciousness. A therapeutic response to a medication that prevents migraine headaches may assist to ratify the diagnosis of ACA secondary to basilar migraine4646 Kaniecki RG. Basilar-type migraine....
In conclusion, ACA is a syndrome that evolves in less than 72 hours, affecting previously-healthy individuals. Acute cerebellar ataxia is commonly seen in neurological practice and patients are initially seen by clinicians at the emergency department. There is a wide array of causes of ACA, including vascular, neoplastic, nutritional, metabolic, im...
- José Luiz Pedroso, Thiago Cardoso Vale, Pedro Braga-Neto, Pedro Braga-Neto, Lívia Almeida Dutra, Mar...
- 2019
Manual sobre ataxias cerebelares para profissionais de saúde da Rede.12 Prólogo.....16 1. O que é ataxia e como detectá-la na atenção primária.....16 2. Formas de ataxia e o que fazer para definir o diagnóstico.....19
O objetivo do artigo é realizar, com base na literatura científica, uma revisão sobre as abordagens fisioterapêuticas no tratamento da ataxia cerebelar. A metodologia utilizada foi à revisão bibliográfica de referências retiradas das bases de dados como Scielo, Medline, Bireme e Lilacs e da internet de 2006 a 2014.
Dentre as disfunções cerebelares, as ataxias cerebelares são patologias hereditárias com altera-ções neurodegenerativas caracterizada clinicamente pela progressiva ataxia cerebelar juntamente com oftalmoplegia, disartria, disfagia e sinais piramidais e extrapiramidais. Geneticamente, essas desordens podem ser divididas em: autossômica ...
A ataxia espinocerebelar (AEC) é uma patologia caracterizada pelo déficit na execução de movimentos coordenados com progressiva os- cilação postural associada à dificuldade de manutenção do equilíbrio
