Vestibular ataxia

Introduction Vestibular ataxia is caused by damage to the vestibular system and is dominated by balance disorders. It is characterized by a balance disorder between static and exercise. It has the same points as cerebellar ataxia, such as wide base of the feet when standing, unstable body, dumping to the side or rear, and skew when walking. However, there are generally obvious dizziness, nystagmus and abnormal vestibular function tests. Vestibular ataxia is a vestibular lesion that causes spatial dysfunction. It is dominated by balance disorders, showing unstable standing. When walking, it falls to the disease side, walks in a straight line, changes the head position, and the limbs move together; often accompanied by dizziness and vomiting. And nystagmus and so on. The vestibular function of the inner ear temperature change (hot and cold water) test or the rotation test reaction decreases or disappears. The closer the lesion is to the inner ear, the more the loss is.

Cause

According to different lesions, it can be divided into peripheral vestibular ataxia and central vestibular ataxia. The former is caused by lesions of the vestibular to vestibular nerve of the inner ear, and the latter is caused by lesions of the vestibular nucleus and its central nervous system.

(1) Viral infection: After the disease, serum levels were measured, and the herpes simplex and herpes zoster virus titers were significantly increased.

(B) vestibular nerves are stimulated: vestibular nerves suffer from vascular compression or arachnoid adhesions, and even due to stenosis of the internal auditory canal caused by hypoxic degeneration, caused by the stimulation of nerve discharge.

(C) the disease factors: there may be their own immune response.

(D) Diabetes: Diabetes can cause degeneration and atrophy of vestibular neurons, leading to repeated vertigo attacks.

an examination

Related inspection

Ataxia checkpoint auditory nerve examination foot beat test closed eyes upright test cross walk test

Physical examination

1. Finger nose test: When the ataxia is at a loss, the action is light and heavy, and the speed is not the same. If you misunderstand or adjust, you can point to the target. When the cerebellar hemisphere lesions are manifested, the more the ataxia is closer to the target, the more obvious the ataxia is, and the poor distance can often exceed the target. In the case of sensory ataxia, the blink of an eye is a barrier to movement, but when the eyes are closed, there is a clear ataxia.

2, knee squat test: cerebellar damage caused by poor positioning and intentional tremor when lifting legs and knees, often swaying when moving down; when sensory ataxia, the patient's heel often can not find the knee, move down The swing is uncertain.

3, rapid rotation test: cerebellum damage when the action is clumsy, uneven rhythm.

4, rebound test: cerebellar lesions. Patients often cause excessive movement and attack themselves.

5, over-finger test: vestibular ataxia, when the upper limbs decline, the side of the disease is lost; when the sensory ataxia, the eyes of the examiner are often not found when closing the eyes.

6. Toe-finger test: The patient is lying on his back and lifting the big toe to reach the extended finger.

7. Sit-up test: The pith and the trunk of the patient with cerebellar damage are flexed at the same time, and the lower limbs are lifted up, which is called combined flexion sign.

Auxiliary inspection

1, cerebellar ataxia should be examined brain CT or MRI to exclude cerebellar tumors, metastases, tuberculoma or abscess and vascular disease and cerebellar degeneration and atrophy.

2, deep sensory ataxia such as localized lesions located in the peripheral nerve should be examined EMG, somatosensory evoked potential; such as in the posterior root lesion or posterior cord lesion should be examined EMG, evoked potential, MRI of the lesion, cerebrospinal fluid Check, or myelography. It is best to check brain CT or MRI when considering the thalamus or parietal lobe.

3, cerebral ataxia should be checked for brain CT or MRI, EEG and so on.

4, vestibular ataxia can be checked for electrical audiometry, auditory evoked potentials, vestibular function tests.

Differential diagnosis

Sensory

Deep feeling reflects the position and direction of movement of various parts of the body to the central nervous system. The causes are:

(1) peripheral nerve or radiculopathy; (2) subacute combined degeneration of the spinal cord, skull base deformity, myelopathy, tumor; (3) brain stem vascular diseases such as infarction, hemorrhage, multiple sclerosis, tumor; (4) Thalamic parietal pathway or parietal vascular disease, tumor.

Vestibular

The vestibular system conducts balance information to the center of the heart, causing an equilibrium response such as body position, line of sight adjustment, and spatial positioning sensation. The causes are:

(1) labyrinthitis, vestibular neuritis, idiopathic bilateral vestibular disease; (2) vertebral-basal artery stenosis or occlusion; (3) tumor under the canopy.

3. Cerebellum

The cerebellum is the regulating center of exercise. The function of these structures is all done under the unified control of the cerebral cortex. The causes are:

(1) hereditary; (2) primary or metastatic tumor; (3) vascular such as infarction, hemorrhage; (4) inflammatory such as acute cerebellitis, abscess; (5) poisoning such as alcohol, food, drugs (6) demyelinating; (7) hypoplasia or malnutrition; (8) hereditary; (9) trauma; (10) calcification; (11) malformation.

Frontal lobe

The lesion is in the front of the frontal lobe, and the dysmotility is the contralateral side. The causes are:

(1) tumor; (2) inflammation; (3) vascular disease.

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