Understanding Neurology

Disorders of motility 179Table 39 Presentations of cerebellar ataxiaAcute (over hours to days)Acute, reversible Viral and postinfective cerebellitis (Case 1)Acute, relapsingEpisodic ataxiasMultiple sclerosisMetabolic encephalopathies (hyperammonaemias)Toxic (alcohol, phenytoin, barbiturates)Acute, persistentCerebellar infarctsCerebellar haemorrhage (e.g. hypertensive), abscess, or metastasesWernicke–Korsakoff syndromeHyperthermiaOpsoclonus-myoclonusSubacute (over days to weeks) or chronic (months)Pure cerebellar syndromeParaneoplastic (associated with gynaecological or small-cell lung tumours)Alcohol–nutritionalToxic (lithium, mercury, gasoline, glue, cytotoxics)Cerebellar syndrome associated Posterior fossa tumours (medulloblastoma, astrocytoma, haemangioblastoma,with additional signs or symptoms acoustic Schwannoma)Chronic subdural haematomaMultiple sclerosisHypothyroidismHashimoto's encephalomyelitisLyme diseaseCoeliac diseaseSuperficial siderosisCerebellar syndrome with dementia Creutzfeldt–Jakob diseaseChronic (months to years)Childhood or early-onsetCongenital cerebellar ataxiaHeredofamilial (e.g. Friedreich's ataxia)Ataxia-telangiectasiaAtaxia associated with hereditary metabolic diseasesCerebellar syndrome with myoclonic epilepsy (e.g. Lafora body disease,Unverricht–Lundborg syndrome)Adulthood or late-onsetSporadic (olivopontocerebellar atrophy and inherited spinocerebellar degenerationspinocerebellar ataxia 1,2,3 etc.)Multiple system atrophyAny ageCraniocervical junction anomalies (Chiari malformation, Dandy–Walker syndrome)Table 40 Causes of sensory ataxiaDemyelinating peripheral neuropathies ('sensory ataxicneuropathy'):❏ Chronic inflammatory demyelinating neuropathy❏ Inherited neuropathy (Charcot–Marie–Tooth disease)❏ Paraproteinaemic neuropathy❏ SarcoidosisDorsal root ganglionopathy❏ Infective (syphilis, Lyme disease)❏ Toxic (e.g. pyridoxine)❏ Paraneoplastic (subacute sensory neuropathy)❏ Sjögren’s syndromeLesions affecting dorsal column in the spinal cord❏ Compression of the cervical or thoracic spinal cord (e.g.meningioma)❏ Inherited spinocerebellar degeneration (e.g. Friedreich’sataxia)❏ Multiple sclerosis❏ Syphilis❏ Vitamin B 12deficiencyLesions affecting medial lemniscus or its centralprojection❏ Multiple sclerosis❏ Vascular (infarct)❏ Tumours