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Morning Report

Morning Report. October 26, 2010. Ataxia. Disturbance in the smooth, accurate coordination of movements Most commonly unsteady gait Result of cerebellar dysfunction or proprioception. Acute Infections Post-infectious Toxins Tumors Trauma Stroke. Intermittent Migraine Seizure IEM

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Morning Report

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  1. Morning Report October 26, 2010

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

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

  4. 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

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

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

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

  8. 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

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

  10. 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

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

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

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

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

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

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