Sensitive ataxia: causes, clinical manifestations, diagnosis, treatment

Gait is a set of individual characteristics of a person( body tilt, position of hands and feet, turn of the head, etc.).To implement the walking process, mechanisms are involved that regulate balance, maintaining the posture and coordinating movements. One such mechanism is the path of deep sensitivity. It is a reflex arc that closes at different levels of the central nervous system. Nerve endings of conductors of deep sensitivity are located in the thickness of muscles, tendons and skin. They carry information in the dorsal and brain about the position of the body in space, the feeling of pressure and vibration. If damaged nerve fibers, which are responsible for deep types of sensitivity, develop a sensitive ataxia. The term "ataxia" is used to denote the violation of coordination of movements.

Reasons for

Sensitive ataxia can develop in a wide variety of neurological diseases, in particular, with multiple sclerosis

The reflex arc of deep sensitivity includes the following departments that participate in coordinating movements at different levels: posterior cord of the spinal cord, posterior spinal cord, medial loop in the brainstem and thalamus, peripheral nerves, parietal lobesbrain.

The defeat of these structures can be for various diseases:

• autoimmune processes( multiple sclerosis);
• neurosyphilis;
• vascular disorders( strokes);
• oncological processes and paraneoplastic syndrome;
• Infectious-inflammatory diseases of the spinal cord( myelitis);
• deficiency of vitamin B12 with spinal cord injury( funicular myelosis);
• is a hereditary disease;
• traumatic spinal cord injury.

Clinical manifestations of

The main symptom is a violation of gait. The patient ceases to "understand" his body while moving. When walking, a man widely spreads his feet, striking his heels on the ground( "stamping gait"), legs bent at the knee and hip joints. Insufficient information about the position of the body in space, a person tries to compensate for by increased visual control, so the symptoms intensify when the eyes are closed or in the dark. The patient himself describes his feelings as "walking on a soft carpet", "on cotton wool."With arms outstretched in the horizontal plane, the human body begins to deviate in different directions. Tremor is not characteristic of a sensitive ataxia. A person can not reach the tip of his nose with his finger when he closes his eyes, misses. Speech with this form of ataxia does not change, but the letter on the side of the defeat of the conductors of deep sensitivity is hampered. There are difficulties in performing simple, purposeful movements: you can not get into the keyhole with a key, button up buttons, bring a spoon to your mouth. In rest, the fingers can make chaotic movements, but with the directed movement they disappear( pseudoathetosis).

The clinical picture of a sensitive ataxia in different people can be different. This is due to the level of damage to the conductors of deep sensitivity in each individual patient.

When the pathological process is localized at the level of the lumbar spinal cord, the ataxia of the lower limbs predominates in the clinical picture, the movements in the hands are normal. If the cervical spinal cord is affected, then ataxia manifests itself in the arms and legs. The defeat of cortical centers in the parietal lobe leads to the development of symptoms on the opposite side of the body.

Diagnosis

A person with sensitive ataxia describes their sensations when walking, like "walking on a soft carpet" or "walking on cotton wool".

Sensitive ataxia is revealed by a primary examination of the patient by a neurologist. To identify the cause of the disease, use the following diagnostic methods:

• neurological examination allows excluding other ataxia( cerebellum, cortical or vestibular) or to identify their combination;
• biochemical blood test;
• lumbar puncture. Investigation of cerebrospinal fluid is necessary for the detection of multiple sclerosis, neurosyphilis or other inflammatory processes in the central nervous system;
• CT and MRI of the brain and spinal cord;
• ENMG( electroneuromyography).Peripheral nerves and muscles are being studied;
• consultation of a geneticist for the detection of hereditary diseases.

Treatment of

Treatment measures include etiotropic, pathogenetic and symptomatic therapy.

Etiotropic and pathogenetic therapy is aimed at eliminating the cause of the disease.

1. Antibacterial agents are prescribed for the infectious nature of a sensitive ataxia.
2. Vascular medications are used to detect a spinal or cerebral stroke.
3. Vitamin B12 with funicular myelosis.
4. Chemotherapy for malignant processes, etc.

Symptomatic therapy aims to alleviate the symptoms of the disease.

1. Neurometabolic agents( vitamins of group B, proserin, ATP, etc.) contribute to the restoration of nerve fibers, improve the excitation of the nerve.
2. Nootropics are used for vascular disorders in the brain.
3. LFK.Complexes of exercises are aimed at training coordination of movements.
4. Massage strengthens muscles and in combination with exercise therapy leads to a faster recovery of a person.

Sensitive ataxia can be completely reversible if it is possible to eliminate the cause of the disease. If the hereditary nature of ataxia or malignant processes is unfavorable, support therapy is prescribed to slow the progression of ataxia.