Cerebellar dysfunction symptoms. Structure and functions of the cerebellum. Efferent pathways of the cerebellum

Symptoms of cerebellar damage

1. Hyporeflexia.
2. Handwriting disorders.

Conclusion

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Damage to the cerebellum can be caused by a variety of consequences. This is due to the fact that it is connected to almost all parts human body, in particular, with nervous system. As a rule, numerous unpleasant symptoms and the appearance of problems with this organ are most often called cerebellar ataxia. It manifests itself in the form of coordination disorder, imbalance, etc. In this case, a person cannot stay in the same position for a long time.

Some of the symptoms of cerebellar damage can be detected with the naked eye. However, more complex hidden signs can be detected only with the help of special laboratory tests. The effectiveness of treatment for these pathologies depends on the causes of the lesions.

Main functions

The cerebellum performs great amount work. First of all, it maintains and distributes muscle tone, which is necessary to keep the human body in balance. Thanks to the work of this organ, a person can perform motor function. Therefore, when talking about the function and symptoms of cerebellar damage, the doctor first of all checks the person’s coordination. This is because this organ helps maintain and distribute muscle tone at the same time. For example, when a person bends his leg, he simultaneously tenses the flexor and relaxes the extensor.

In addition, the cerebellum distributes energy and minimizes contraction of the muscles that are involved in performing a particular job. In addition, this organ is necessary for motor learning. This means that during training or developing professional skills, the body remembers which muscle groups contract and tense.

If there are no symptoms of cerebellar damage and its functioning is normal, then in this case the person feels well. If at least one part of this organ suffers from damage, then it becomes more difficult for the patient to perform certain functions, or he simply cannot move.

Neurological pathology

Because of the defeat of this important body a huge amount can develop serious illnesses. If we talk about neurology and symptoms of cerebellar damage, it is worth noting the most main danger. Damage to this organ leads to poor circulation. The appearance of this pathology can lead to:

• Ischemic stroke and other heart diseases.
• Multiple sclerosis.
• Traumatic brain injury. In this case, the lesion does not always have to affect the cerebellum; it is enough if at least one of its connections is disrupted.
• Meningitis.
• Diseases of a degenerative type, as well as abnormalities caused in the nervous system.
• Intoxication.
• Overdose of certain medications.
• Vitamin B12 deficiency.
• Hydrocephalus of obstructive type.

In neurology, symptoms of cerebellar damage are quite common. Therefore, first of all, it is necessary to visit a specialist in this particular field.

Cause of cerebellar diseases

In this case, we can talk about injuries, congenital underdevelopment of this area, circulatory disorders, or the consequences of long-term drug use. This can also happen due to toxin poisoning.

If a patient is diagnosed with a congenital defect in the development of this organ, then in this case we're talking about that a person suffers from a disease called Marie's ataxia. This pathology refers to dynamic ailments.

Symptoms of damage to the cerebellum and pathways may indicate a stroke, injury, cancer, infections and other pathologies occurring in the nervous system. Similar illnesses are encountered by people who have had a fracture of the base of the skull or damage to the occipital region heads.

If a person suffers from atherosclerotic vascular lesions, this can also provoke a disruption of the blood supply to the cerebellum. However, the list of all ailments does not end there. Damage to the carotid artery and vascular spasms, which turn into hypoxia, can also provoke a similar condition.

In addition, it should be taken into account that most often symptoms characteristic of cerebellar damage occur in older people. This is explained by the fact that their vessels lose elasticity over time and are affected by atherosclerosis and cholesterol plaques. Because of this, their walls cannot withstand strong pressure and begin to break apart. Such hemorrhage provokes tissue ischemia.

Signs of pathology

If we talk about the main symptoms of damage to the cerebellum of the brain, then among them is ataxia, which can manifest itself in different ways. However, most often a person’s head and whole body begin to tremble, even with a calm body position. Muscle weakness and poor coordination of movements appear. If one of the hemispheres of the brain is damaged, then the person’s movements will be asymmetrical.

Patients also suffer from tremors. In addition, there are strong problems during the process of flexion and extension of the limbs. Many experience hypothermia. If symptoms characteristic of cerebellar damage occur, the patient may experience motor disturbances. In this case, when moving towards a certain goal, a person begins to perform pendulum actions. In addition, a problem with the cerebellum can cause hyperreflexia, gait disturbances, and severe changes in handwriting. It is also worth considering the types of ataxia of this organ.

Static-locomotor

In this case, disturbances in a person’s walking are most pronounced. Any movement brings severe stress, which causes the body to become weaker. In this case, it is difficult for a person to be in a position where the heels and toes of the feet are in contact. Difficulty falling forward, backward, or swaying to the sides. In order to take a stable position, a person needs to spread his legs wide apart. There is a very unsteady gait and outwardly the patient who exhibits symptoms of cerebellar damage resembles a drunk. When turning, it can skid to the side, even falling.

To diagnose this pathology, several tests must be performed. First of all, you need to ask the patient to walk in a straight line. If he shows the first signs of static-locomotor ataxia, he will not be able to perform this simple procedure. In this case, he will begin to deviate too much in different directions or spread his legs too wide.

Also, in order to identify the main symptoms of cerebellar damage, additional tests are performed at this stage. For example, you can ask the patient to stand up sharply and turn 90° to the side. A person whose cerebellum is damaged will not be able to perform this procedure and will fall. With such a pathology, the patient also cannot move with an extended step. In this case, he will dance, and the body will begin to lag slightly behind the limbs.

In addition to obvious problems with gait, there is a strong contraction of muscles when performing even the simplest movements. Therefore, in order to determine this pathology, you need to ask the patient to stand up sharply from a lying position. At the same time, his arms should be crossed on his chest. If a person is healthy, then his muscles will contract synchronously, and he will be able to sit down quickly. When ataxia occurs and the first symptoms of cerebellar damage occur, it becomes impossible to simultaneously strain the hips, torso and lower back. A person will not be able to get into a sitting position without the help of his hands. Most likely the patient will simply fall backwards.

You can also ask the person to try bending backwards while standing. At the same time, he must throw back his head. If a person is in in good condition, then in this case he will involuntarily bend his knees and straighten in the hip area. With ataxia, such flexion does not occur. Instead, the person falls.

In this case, we are talking about problems with the smoothness and dimension of human movements. This type of ataxia can be unilateral or bilateral, depending on which hemispheres are affected. If we talk about what symptoms are observed with damage to the cerebellum and the manifestation of dynamic ataxia, they are similar to those described above. However, if we are talking about unilateral ataxia, then in this case there are problems with movement or performance test tasks a person will only have them on the right or left side of the body.

To identify the dynamic form of pathology, it is worth paying attention to some features of human behavior. First of all, he will experience severe trembling in his limbs. As a rule, it intensifies by the time the patient completes the movement. Being in calm state, the person looks absolutely normal. However, if you ask him to take a pencil from the table, at first he will stretch out his hand without any problems, but as soon as he begins to take the object, his fingers will begin to tremble violently.

When determining the symptoms of cerebellar damage, diagnosis includes additional tests. With the development of this pathology, patients experience so-called overshooting and overshooting. This is explained by the fact that a person’s muscles begin to contract disproportionately. The flexors and extensors work much harder. As a result, a person cannot fully perform the most simple steps, for example, putting a spoon in your mouth, buttoning a shirt, or tying a knot in your shoelaces.

In addition, changes in handwriting are a clear sign of this disorder. Most often, patients begin to write large and unevenly, and the letters become zigzag.

Also, when determining symptoms of damage to the cerebellum and pathways, it is worth paying attention to how a person speaks. With the dynamic form of the disease, a sign appears, which in medical practice is called scanned speech. In this case, the person speaks as if in jerks. It divides phrases into several small fragments. In this case, outwardly the patient looks as if he is broadcasting something to a large number of people from the podium.

Other phenomena characteristic of this disease are also observed. They also concern patient coordination. Therefore, the doctor conducts a number of additional tests. For example, in a standing position, the patient should straighten and raise his arm to horizontal position, take her to the side, close your eyes and try to touch your nose with your finger. In normal conditions, it will not be difficult for a person to perform this procedure. If he has ataxia, he will always miss.

You can also try asking the patient to close his eyes and touch the tips of two index fingers to each other. If there are problems in the cerebellum, the patient will not be able to match the limbs in the desired way.

Diagnostics

Considering the symptoms of cerebellar damage and research methods, it is worth noting that in case of any disturbances in the functioning of the brain, you must immediately contact a neurologist. He conducts a series of tests in order to clarify how a person’s superficial and deep reflexes work.

If we talk about hardware studies, it may be necessary to perform electronystagmography and vestibulometry. Required general analysis blood. If a specialist suspects an infection in the cerebrospinal fluid, a lumbar puncture is performed. Markers of stroke or inflammation need to be checked. Additionally, an MRI of the brain may be required.

Treatment

The success of therapy directly depends on the causes of this pathology. Therefore, speaking about the symptoms and treatment of cerebellar lesions, it is worth considering the most common cases.

If the disease is accompanied by an ischemic stroke, then lysis of blood clots is required. The specialist also prescribes fibrinolytics. To prevent the formation of new blood clots, antiplatelet agents are prescribed. These include Aspirin and Clopidogrel. Additionally, you may need to take metabolic medications. These include Mexidol, Cytoflavin and others. These funds help improve metabolic processes in brain tissue.

In addition, in order to prevent another stroke, it is necessary to take a course of medications that reduce the amount of cholesterol in the blood.

If, when studying the symptoms and causes of damage to the cerebellum, the doctor determines that the patient is suffering from neuroinfections (for example, encephalitis or meningitis), then treatment with antibiotics is required.

Problems caused by intoxication in the body can be solved with the help of detoxification therapy. However, for this it is necessary to clarify the type and characteristics of the poison. In difficult situations, immediate measures must be taken, so the doctor performs forced diuresis. In case of food poisoning, it is enough to perform gastric lavage and take sorbents.

If a patient is diagnosed with cancer, then everything depends on its stage and type of pathology. As a rule, radiation and chemotherapy are prescribed for treatment. In some situations, surgery may be required.

Experts also prescribe drugs that can improve blood flow (for example, “Caviton”), vitamin complexes, anticonvulsants and drugs that strengthen muscle tone.

Physical therapy and massage sessions have a beneficial effect. Thanks to a special set of exercises, it is possible to restore muscle tone. This helps the patient return to normal faster. Physiotherapeutic activities are also carried out ( medicinal baths, electrical stimulation, etc.).

Also, when considering the symptoms, causes and treatment of cerebellar damage, it is worth paying attention to several more brain pathologies encountered in medical practice.

Betten's disease

This pathology belongs to the category of hereditary diseases. It doesn't happen that often. In this case, a person exhibits all the signs of cerebellar ataxia, which are recorded in babies in the first 12 months of life. Serious problems in coordination appear, the child cannot focus his gaze, and muscle hypotonia appears.

Some children begin to hold their heads independently only by the age of 2-3 years, and later begin to speak and walk. However, in most cases, after a few more years, the baby’s body adapts to the pathology, and the signs cerebellar lesion cease to be obvious.

Holmes cerebellar degeneration

With progressive cerebellar atrophy, the dentate nuclei are most damaged. In addition to the standard signs of ataxia, patients experience epileptic seizures. However, on intellectual abilities This pathology usually does not affect humans. There is a theory that this pathology is hereditary, but exact scientific evidence of this fact does not exist today.

Alcoholic cerebellar degeneration

A similar pathology appears against the background of chronic intoxication with alcoholic beverages. In this case, the cerebellar vermis is affected. First of all, when diagnosing the disease, patients experience problems with limb coordination. Sight and speech are impaired. Patients suffer from severe memory loss and other problems with brain activity.

Based on this, it becomes obvious that problems with the cerebellum appear against the background of other pathologies. Although neurological problems most often lead to ataxia, this is not the only factor that affects a person’s health. Therefore, it is important to promptly pay attention to symptoms and contact qualified specialist and carry out diagnostics. Simple tests can be performed at home. However, after this you need to consult a doctor to identify the main cause of the appearance. unpleasant disease and start immediate treatment with the help of medications and physical therapy.

• multiple sclerosis;
• meningitis, meningoencephalitis;
• vitamin B12 deficiency;
• obstructive hydrocephalus.

Symptoms of cerebellar ataxia

Static-locomotor ataxia

Dynamic cerebellar ataxia

Treatment of cerebellar ataxia

The cerebellum is a part of the central nervous system located under the cerebral hemispheres. It has the following formations: two hemispheres, legs and a worm. Responsible for coordination of movements and muscle function. With lesions of the cerebellum, symptoms manifest themselves as motor disturbances, changes in speech, handwriting, gait, and loss of muscle tone.

Causes of cerebellar diseases

The causes of cerebellar diseases can be injuries, congenital underdevelopment of this structure, as well as circulatory disorders, the consequences of drug addiction, substance abuse, neuroinfections, and intoxication. There is a congenital defect in the development of the cerebellum caused by genetic pathology, called Marie's ataxia.

Important! Damage to the cerebellum can result from strokes, injuries, cancer, infections of the nervous system, and intoxication.

Cerebellar injuries are observed with fractures of the base of the skull and injuries to the occipital part of the head. Violation of the blood supply to the cerebellum occurs when atherosclerotic lesion vessels, as well as in ischemic, hemorrhagic stroke of the cerebellum.

Atherosclerosis of the vessels directly supplying the cerebellum, as well as sclerotic lesions carotid arteries in combination with vasospasm, they can cause transient hypoxia (transient ischemic attacks). Ischemic stroke is usually caused by blockage of a vessel with a thrombus or emboli of various origins (air, cholesterol plaque). It also manifests itself as a dysfunction of the cerebellum.

Hemorrhagic stroke of the cerebellum, i.e. hemorrhage due to a violation of the integrity of the vessel is a common cause of impaired coordination of movements, speech, and eye symptoms. Hemorrhages into the cerebellar substance occur when high blood pressure and hypertensive crises.

In older people, the vessels are not elastic, are affected by atherosclerosis and are covered with calcified cholesterol plaques, so they cannot withstand high pressure and their walls rupture. The result of hemorrhage is ischemia of the tissues that received nutrition from the ruptured vessel, as well as the deposition of hemosiderin in the intercellular substance of the brain and the formation of a hematoma.

Oncological diseases associated directly with the cerebellum, or with metastases, also cause disorders of this structure. Sometimes cerebellar lesions are caused by impaired outflow of cerebral fluid.

Symptoms of cerebellar damage

The key symptom of cerebellar damage is cerebellar ataxia. It manifests itself in trembling of the head and the whole body at rest and during movement, incoordination of movements, and muscle weakness. Symptoms of cerebellar diseases can be asymmetrical if one of the hemispheres is damaged. The main manifestations of pathology in patients are identified:

1. Intention tremor, one of the symptoms of cerebellar damage, manifests itself in sweeping movements and excessive amplitude at the end.
2. Postural tremor is a shaking of the head and body at rest.
3. Dysdiadochokinesis manifests itself in the impossibility of rapid opposite muscle movements - flexion and extension, pronation and supination, adduction and abduction.
4. Hypometry is the stopping of a motor act without achieving its goal. Hypermetry is an increase in pendulum-like movements when approaching the achievement of the goal of the movement.
5. Nystagmus is an involuntary movement of the eyes.
6. Muscle hypotension. The patient's muscle strength decreases.
7. Hyporeflexia.
8. Dysarthria. Scanned speech, i.e. patients emphasize words rhythmically and not in accordance with the rules of orthoepy.
9. Gait disturbance. Shaky movements of the body do not allow the patient to walk in a straight line.
10. Handwriting disorders.

Diagnosis and treatment of cerebellar disorders

The neurologist examines and tests superficial and deep reflexes. Electronystagmography and vestibulometry are performed. A general blood test is prescribed. Lumbar puncture performed to determine infection in the cerebrospinal fluid, as well as markers of stroke or inflammation. Magnetic resonance imaging of the head is performed. The condition of the cerebellar vessels is determined using Dopplerography.

Treatment of cerebellar diseases in ischemic stroke is carried out using thrombus lysis. Fibrinolytics (streptokinase, alteplase, urokinase) are prescribed. To prevent the formation of new blood clots, antiplatelet agents (aspirin, clopidogrel) are used.

For ischemic and hemorrhagic strokes, metabolic drugs (Mexidol, Cerebrolysin, Cytoflavin) improve metabolism in brain tissue. To prevent recurrent strokes, drugs that lower blood cholesterol are prescribed, and in case of hemorrhagic hemorrhage, antihypertensive drugs are prescribed.

Neuroinfections (encephalitis, meningitis) require antibiotic therapy. Pathologies of the cerebellum caused by intoxications require detoxification therapy, depending on the nature of the poisons. Forced diuresis, peritoneal dialysis and hemodialysis are performed. When food poisoning– gastric lavage, administration of sorbents.

For oncological lesions of the cerebellum, treatment is carried out in accordance with the type of pathology. Chemotherapy and radiation therapy, or surgery. If the outflow of cerebrospinal fluid is disrupted, causing cerebellar syndrome, an operation is performed with craniotomy and shunting of the pathways for the outflow of cerebrospinal fluid.

Conclusion

Damage to the cerebellum, the consequence of which can be disability, the patient’s need for care, requires timely and thorough treatment, as well as care and rehabilitation of the patient. If there is a sudden disturbance in gait or speech disorder, it is necessary to visit a neurologist.

The cerebellum is a part of the brain that is responsible for the coordination of movements, as well as the ability to ensure body balance and regulate muscle tone.

Basic functions and disorders of the cerebellum

The structure of the cerebellum itself is similar to the structure of the cerebral hemispheres. The cerebellum has a cortex and white matter underneath, which consists of fibers with cerebellar nuclei.

The cerebellum itself is closely connected with all parts of the brain, as well as with the spinal cord. The cerebellum is primarily responsible for the tone of the extensor muscles. When cerebellar function is impaired, characteristic changes, which is commonly called “cerebellar syndrome”. At this stage of development of medicine, it has been revealed that the cerebellum is related to the impact on many important functions body.

If the cerebellum is damaged, various motor activity disorders may develop, autonomic disorders may appear, and muscle tone may be impaired. This happens due to close connection cerebellum with brain stem. Therefore, the cerebellum is the center of coordination of movements.

Main symptoms of cerebellar damage

When the cerebellum is damaged, muscle function is disrupted, making it difficult for the patient to keep the body in balance. Today, there are main signs of cerebellar motor coordination disorders:

• intention tremor
• voluntary movements and slow speech
• the smoothness of movements of the arms and legs is lost
• handwriting changes
• speech becomes chanted, the placement of stress in words is more rhythmic than semantic

Cerebellar disorders of motor coordination are expressed in gait disturbances and dizziness - ataxia. Difficulties may also arise when trying to rise from a lying position. The combination of simple movements and complex motor acts is disrupted, since the cerebellar system is affected. Cerebellar ataxia causes the patient to have an unsteady gait, which is characterized by staggering from side to side. Also, when looking away to the extreme position, a rhythmic twitching may be observed. eyeballs, this is how a violation of the movement of the oculomotor muscles manifests itself.

There are different types of ataxia, but they are all similar in one main feature, namely movement disorder. The patient has statistical violations; even if he is pushed, he will fall without noticing that he is falling.
Cerebellar ataxia is observed in many diseases: hemorrhages of various origins, tumors, hereditary defects, poisoning.

Cerebellar congenital and acquired diseases

Diseases associated with the cerebellum can be congenital or acquired. Congenital genetic disease The dominant type is Marie's hereditary cerebellar ataxia. The disease begins its manifestation with a lack of coordination of movements. This is due to hypoplasia of the cerebellum and its connections with the periphery. Often this disease is accompanied by a gradual manifestation of a decrease in intelligence, and memory is impaired.

During treatment, the type of inheritance of the disease is taken into account, at what age the first symptoms, changes, and deformities of the skeleton and feet appeared. There are also several other variants of chronic atrophy of the cerebellar system.

Typically, doctors prescribe conservative treatment to a patient with this diagnosis. This treatment can significantly reduce the severity of symptoms. During treatment, the nutrition of nerve cells can be significantly increased, as well as blood supply improved.

Acquired cerebellar disease can result from traumatic brain injury when a traumatic hematoma occurs. Having established this diagnosis, doctors perform surgery to remove the hematoma. Also, damage to the cerebellum can be caused by malignant tumors, the most common of which are medulloblastomas and sarcomas. Stroke-infarction of the cerebellum can also cause hemorrhage, which occurs with atherosclerosis of blood vessels or a hypertensive crisis. With such diagnoses, surgical treatment of the cerebellum is usually prescribed.

Currently, transplantation of individual parts of the brain is not possible. This is due to ethical considerations, since the death of a person is determined by the fact of brain death; therefore, when the owner of the brain is still alive, he cannot be an organ donor.

Cerebellar stroke: causes and treatment

A cerebellar stroke occurs when the blood supply to a given area of ​​the brain is interrupted. Brain tissue that does not receive oxygen from the blood and nutrients quickly dies and this leads to the loss of some body functions. Therefore, a stroke is a life-threatening condition and requires emergency medical care.

There are two types of cerebellar stroke:

• ischemic
• hemorrhagic

Most frequent form is an ischemic cerebellar stroke, which occurs as a result of sharp decrease blood flow to the brain area. In turn, this condition can cause:

• a clot that blocks the flow of blood into a blood vessel
• a clot (thrombus) that has formed in an artery that carries blood to the brain
• when a blood vessel ruptures and a cerebral hemorrhage occurs

The consequences of a cerebellar stroke are: excessive sweating, uneven breathing, excessive pallor, rapid heartbeat, unstable pulse, redness of the face. To dissolve the blood clot that caused ischemic stroke, carry out emergency treatment. Also health care necessary to stop bleeding during a hemorrhagic stroke.

During the treatment of ischemic cerebellar stroke, it is prescribed medications, which help dissolve blood clots and prevent their formation, prescribe blood thinners to control blood pressure, for the treatment of irregular heart rate. To treat ischemic cerebellar stroke, your doctor may perform surgery. It is strictly forbidden to self-medicate, because the wrong approach to the problem can cause the condition to worsen.

Coordination of movements is a natural and necessary quality of any living creature that has mobility, or the ability to arbitrarily change its position in space. This function must be performed by special nerve cells.

In the case of worms that move on a plane, there is no need to allocate a special organ for this. But already in primitive amphibians and fish, a separate structure appears, which is called the cerebellum. In mammals, this organ is improved due to the variety of movements, but it has received the greatest development in birds, since the bird perfectly masters all degrees of freedom.

A person has a specific movement pattern that is associated with the use of hands as tools. As a result, coordination of movements turned out to be unthinkable without mastering fine motor skills of the hands and fingers. In addition, the only way a person can move is by walking upright. Therefore, coordination of the position of the human body in space is unthinkable without constantly maintaining balance.

It is these functions that distinguish the human cerebellum from a seemingly similar organ in other higher primates, and in a child it must still mature and learn proper regulation. But, like any individual organ or structure, the cerebellum can be affected by various diseases. As a result, the above functions are disrupted and a condition called cerebellar ataxia develops.

How does a “normal” cerebellum work?

Before approaching the description of diseases of the cerebellum, it is necessary to briefly talk about how the cerebellum is structured and how it functions.

The cerebellum is located at the bottom of the brain, under the occipital lobes of the cerebral hemispheres.

It consists of a small middle section, the vermis, and hemispheres. The vermis is an ancient section, and its function is to ensure balance and statics, and the hemispheres developed along with the cerebral cortex, and provide complex motor acts, for example, the process of typing this article on a computer keyboard.

The cerebellum is closely connected to all the tendons and muscles of the body. They contain special receptors that “tell” the cerebellum what state the muscles are in. This sense is called proprioception. For example, each of us knows, without looking, in what position and where his leg or arm is, even in the dark and at rest. This sensation reaches the cerebellum via the spinocerebellar tracts that ascend in the spinal cord.

In addition, the cerebellum is connected to the system of semicircular canals, or vestibular apparatus, as well as with conductors of joint-muscular sensation.

The olivocerebellar pathway passes through the inferior cerebellar peduncles, which connects it with the extrapyramidal system of unconscious movements. The reverse, efferent pathway is the path from the cerebellum to the red nuclei.

It is this path that works brilliantly when, having slipped, a person “dances” on the ice. Without having time to figure out what is happening, and without having time to get scared, the person restores his balance. This triggered a “relay” that switched information from the vestibular apparatus about changes in body position immediately through the cerebellar vermis to the basal ganglia, and then to the muscles. Since this happened “automatically”, without the participation of the cerebral cortex, the process of restoring balance occurs unconsciously.

The cerebellum is closely connected to the cerebral cortex, regulating conscious movements of the limbs. This regulation occurs in the cerebellar hemispheres

What is cerebellar ataxia?

Translated from Greek, taxis is movement, taxis. And the prefix “a” means negation. In the broadest sense of the word, ataxia is a disorder of voluntary movements. But this disorder can occur, for example, during a stroke. Therefore, an adjective is added to the definition. As a result, the term “cerebellar ataxia” refers to a set of symptoms that indicate a lack of coordination of movements, the cause of which is a dysfunction of the cerebellum.

It is important to know that in addition to ataxia, cerebellar syndrome is accompanied by asynergia, that is, a violation of the consistency of the movements performed relative to each other.

Some believe that cerebellar ataxia is a disease that affects adults and children. In fact, this is not a disease, but a syndrome that can have various reasons, and occur in tumors, injuries, multiple sclerosis and other diseases. How does this cerebellar lesion manifest itself? This disorder manifests itself as static ataxia and dynamic ataxia. What it is?

Static ataxia is a violation of coordination of movements at rest, and dynamic ataxia is a violation of their movement.. But doctors, when examining a patient who suffers from cerebellar ataxia, do not distinguish such forms. Much symptoms are more important, which indicate the location of the lesion.

Symptoms of cerebellar disorders

The function of this body is as follows:

• maintaining muscle tone using reflexes;
• maintaining balance;
• coordination of movements;
• their consistency, that is, synergy.

Therefore, all symptoms of cerebellar damage are, to one degree or another, a disorder of the above functions. Let us list and explain the most important of them.

Atactic gait

Everyone has seen cerebellar ataxia of alcoholic origin, when a heavily drunk person walks in front of you. The “cerebellar” gait looks the same. The legs are spread wide apart, the patient staggers, and “skids” when turning. Also, during gait, various deviations to the side and a fall are possible. And the deviation most often occurs on the affected side, since the cerebellar tracts pass ipsilaterally, without crossing, unlike the pyramidal tract.

Intention tremor

This symptom appears with movement, and is almost not observed at rest. Its meaning is the appearance and intensification of the amplitude of oscillations of the distal limbs when reaching a goal. If you ask a sick person to touch his own nose with his index finger, the closer the finger is to the nose, the more he will begin to tremble and describe various circles. Intention is possible not only in the arms, but also in the legs. This is detected during the heel-knee test, when the patient is asked to hit the knee of the other, extended leg with the heel of one leg.

Nystagmus

Nystagmus is an intention tremor that occurs in the muscles of the eyeballs. If the patient is asked to move his eyes to the side, a uniform, rhythmic twitching of the eyeballs occurs. Nystagmus can be horizontal, less often – vertical or rotatory (rotational).

Adiadochokinesis

This phenomenon can be verified as follows. Ask the seated patient to place their hands on their knees, palms up. Then you need to quickly turn them over with your palms down and up again. The result should be a series of “shaking” movements, synchronous in both hands. If the test is positive, the patient becomes confused and synchrony is disrupted.

Missing, or hypermetry

This symptom manifests itself if you ask the patient to quickly hit an object with the index finger (for example, a neurologist’s hammer), the position of which is constantly changing. The second option is to hit a static, motionless target, but first with your eyes open and then with your eyes closed.

Scanned Speech

Symptoms of speech disorders are nothing more than intentional tremor of the vocal apparatus. As a result, speech acquires an explosive, explosive character and loses its softness and smoothness.

Diffuse muscle hypotonia

Since the cerebellum regulates muscle tone, the cause of its diffuse decrease may be signs of ataxia. IN in this case, the muscles become flabby and sluggish. The joints become “wobbly” because the muscles do not limit the range of motion, and habitual and chronic subluxations may occur.

In addition to these symptoms, which are easy to check, cerebellar disorders can be manifested by changes in handwriting and other signs.

Causes of the disease

It should be said that the cerebellum is not always to blame for the development of ataxia, and the doctor’s task is to figure out at what level the damage occurred. Here are the most characteristic causes of the development of both the cerebellar form and ataxia outside the cerebellum:

• Damage to the posterior cords spinal cord. This causes sensory ataxia. Sensitive ataxia is so named because the patient has impaired joint-muscular sensation in the legs and is unable to walk normally in the dark until he can see his own legs. This condition is characteristic of funicular myelosis, which develops in a disease associated with a lack of vitamin B12.

• Extracerebellar ataxia can develop in diseases of the labyrinth. Thus, vestibular disorders and Meniere's disease can cause dizziness and falling, although the cerebellum is not involved in the pathological process;

• The appearance of neuroma of the vestibulocochlear nerve. This benign tumor may present with unilateral cerebellar symptoms.

The actual cerebellar causes of ataxia in adults and children can occur due to brain injuries, vascular diseases, and also due to a cerebellar tumor. But these isolated lesions are rare. More often, ataxia is accompanied by other symptoms, for example, hemiparesis, dysfunction of the pelvic organs. This happens with multiple sclerosis. If the process of demyelination is successfully treated, then the symptoms of cerebellar damage will regress.

Hereditary forms

However, there is whole group hereditary diseases in which the motor coordination system is predominantly affected. Such diseases include:

• Friedreich's spinal ataxia;
• hereditary cerebellar ataxia of Pierre Marie.

Cerebellar ataxia of Pierre Marie was previously considered a single disease, but now there are several variants of its course. What are the signs of this disease? This ataxia begins late, at the age of 3 or 4, and not at all in a child, as many people think. Despite late start, the symptoms of cerebellar ataxia are accompanied by speech impairment such as dysarthria, increased tendon reflexes. Symptoms are accompanied by spasticity of skeletal muscles.

Typically, the disease begins with a disturbance in gait, and then nystagmus begins, coordination in the hands is impaired, deep reflexes revive, and an increase in muscle tone develops. Poor prognosis occurs with optic nerve atrophy.

This disease is characterized by a decrease in memory, intelligence, as well as impaired control of emotions and volition. The course is steadily progressive, the prognosis is unfavorable.

Sometimes this hereditary ataxia is difficult to differentiate from a tumor of the posterior cranial fossa. But the absence of fundus congestion and intracranial hypertension syndrome allows a correct diagnosis to be made.

About treatment

Treatment of cerebellar ataxia, as a secondary syndrome, almost always depends on success in treating the underlying disease. In the event that the disease progresses, for example, as hereditary ataxias, then in the later stages of the disease the prognosis is disappointing.

If, for example, as a result of a brain contusion in the occipital region, severe coordination disorders occur, then treatment of cerebellar ataxia can be successful if there is no hemorrhage in the cerebellum and there is no cell necrosis.

A very important component of treatment is vestibular exercises, which must be performed regularly. The cerebellum, like other tissues, is capable of “learning” and restoring new associative connections. This means that it is necessary to train coordination of movements not only in case of damage to the cerebellum, but also in case of strokes, diseases inner ear, and other defeats.

There are no folk remedies for cerebellar ataxia, because ethnoscience I had no idea about the cerebellum. The maximum that can be found here is remedies for dizziness, nausea and vomiting, that is, purely symptomatic remedies.

Therefore, if you have problems with gait, tremor, fine motor skills, then you should not put off visiting a neurologist: the disease is easier to prevent than to treat.

Cerebellar ataxia is a syndrome that occurs when a special structure of the brain called the cerebellum or its connections to other parts of the nervous system are damaged. Cerebellar ataxia is very common and can be the result of a wide variety of diseases. Its main manifestations are a disorder of coordination of movements, their smoothness and proportionality, disturbance of balance and maintenance of body posture. Some signs of cerebellar ataxia are visible to the naked eye even to a person without medical education, while others are detected using special tests. Treatment of cerebellar ataxia largely depends on the cause of its occurrence, on the disease from which it is a consequence. You will learn about what can cause cerebellar ataxia, what symptoms it manifests and how to deal with it by reading this article.

The cerebellum is a part of the brain located in the posterior cranial fossa below and behind the main part of the brain. The cerebellum consists of two hemispheres and the vermis, the middle part that connects the hemispheres with each other. The average weight of the cerebellum is 135 g, and its size is 9-10 cm × 3-4 cm × 5-6 cm, but despite such small parameters, its functions are very important. None of us thinks about what muscles need to be tensed in order, for example, to simply sit down or stand up, or take a spoon in our hand. It seems to happen automatically, you just have to want it. However, in fact, to perform such simple motor acts, the coordinated and simultaneous work of many muscles is necessary, which is only possible with the active functioning of the cerebellum.

The main functions of the cerebellum are:

• maintaining and redistributing muscle tone to keep the body in balance;
• coordination of movements in the form of their accuracy, smoothness and proportionality;
• maintenance and redistribution of muscle tone in synergist muscles (performing the same movement) and antagonist muscles (performing multidirectional movements). For example, to bend a leg, you must simultaneously tense the flexors and relax the extensors;
• economical use of energy in the form of minimal muscle contractions necessary to perform a specific type of work;
• participation in motor learning processes (for example, the formation of professional skills associated with the contraction of certain muscles).

If the cerebellum is healthy, then all these functions are carried out unnoticed by us, without requiring any thought processes. If any part of the cerebellum or its connections with other structures is affected, then the performance of these functions becomes difficult and sometimes simply impossible. This is when the so-called cerebellar ataxia occurs.

The spectrum of neurological pathology occurring with signs of cerebellar ataxia is very diverse. The causes of cerebellar ataxia can be:

• violations cerebral circulation in the vertebrobasilar region (ischemic and hemorrhagic stroke, transient ischemic attacks, discirculatory encephalopathy);
• multiple sclerosis;
• tumors of the cerebellum and cerebellopontine angle;
• traumatic brain injury with damage to the cerebellum and its connections;
• meningitis, meningoencephalitis;
• degenerative diseases and anomalies of the nervous system with damage to the cerebellum and its connections (Friedreich's ataxia, Arnold-Chiari anomaly and others);
• intoxication and metabolic damage (for example, alcohol and drug use, lead intoxication, diabetes and so on);
• overdose of anticonvulsants;
• vitamin B12 deficiency;
• obstructive hydrocephalus.

Symptoms of cerebellar ataxia

It is customary to distinguish two types of cerebellar ataxia: static (static-locomotor) and dynamic. Static cerebellar ataxia develops with damage to the cerebellar vermis, and dynamic ataxia develops with pathology of the cerebellar hemispheres and its connections. Each type of ataxia has its own characteristics. Cerebellar ataxia of any type is characterized by a decrease in muscle tone.

Static-locomotor ataxia

This type of cerebellar ataxia is characterized by a violation of the antigravity function of the cerebellum. As a result, standing and walking become too much of a strain on the body. Symptoms of static-locomotor ataxia may include:

• inability to stand straight in the “heels and toes together” position;
• falling forward, backward or swaying to the sides;
• the patient can stand only by spreading his legs wide apart and balancing with his hands;
• unsteady gait (like a drunk);
• when turning, the patient “slides” to the side, and he may fall.

To identify static-locomotor ataxia, several simple tests are used. Here are some of them:

• standing in the Romberg pose. The pose is as follows: toes and heels pushed together, arms extended forward to a horizontal level, palms facing down with fingers spread wide. First, the patient is asked to stand with with open eyes, and then with closed ones. With static-locomotor ataxia, the patient is unstable both with his eyes open and with his eyes closed. If no deviations are detected in the Romberg position, then the patient is asked to stand in a complicated Romberg position, when one leg must be placed in front of the other so that the heel touches the toe (maintaining such a stable position is possible only in the absence of pathology on the part of the cerebellum);
• the patient is asked to walk along a conventional straight line. With static-locomotor ataxia, this is impossible; the patient will inevitably deviate in one direction or another, spread his legs wide apart, and may even fall. They are also asked to stop abruptly and turn 90° to the left or right (with ataxia the person will fall);
• The patient is asked to walk with a side step. Such a gait with static-locomotor ataxia becomes as if dancing, the torso lags behind the limbs;
• "star" or Panov test. This test allows you to identify disorders in mildly expressed static-locomotor ataxia. The technique is as follows: the patient needs to successively take three steps forward in a straight line, and then three steps back, also in a straight line. First, the test is carried out with open eyes, and then with closed ones. If with open eyes the patient is even more or less able to perform this test, then with closed eyes he inevitably turns around (a straight line does not come out).

In addition to impaired standing and walking, static-locomotor ataxia manifests itself as a violation of coordinated muscle contraction when performing various movements. This is called in medicine cerebellar asynergies. Several tests are also used to identify them:

• the patient is asked to sit up sharply from a lying position with his arms crossed over his chest. Normally, the muscles of the trunk and the posterior group of thigh muscles contract synchronously, and the person is able to sit down. With static-locomotor ataxia, synchronous contraction of both muscle groups becomes impossible, as a result of which it is impossible to sit without the help of hands, the patient falls back and one leg rises at the same time. This is the so-called Babinski asynergy in the supine position;
• Babinsky's synergy in a standing position is as follows: in a standing position, the patient is asked to bend back, throwing back his head. Normally, for this, a person will have to involuntarily bend his knees slightly and straighten his hip joints. With static-locomotor ataxia, neither flexion nor extension occurs in the corresponding joints, and an attempt to bend ends in a fall;
• Orzechowski's test. The doctor extends his hands, palms up, and invites the standing or sitting patient to rest his palms on them. Then the doctor suddenly moves his hands down. Normally, the patient's lightning-fast, involuntary muscle contractions cause him to either lean back or remain motionless. This will not work for a patient with static-locomotor ataxia - he will fall forward;
• phenomenon of absence of reverse push ( positive test Stewart-Holmes). The patient is asked to forcefully bend his arm at the elbow joint, and the doctor counteracts this, and then suddenly stops the opposition. With static-locomotor ataxia, the patient's hand is thrown back with force and hits the patient's chest.

Dynamic cerebellar ataxia

In general, its essence lies in the disruption of smoothness and proportionality, accuracy and dexterity of movements. It can be bilateral (with damage to both hemispheres of the cerebellum) and unilateral (with pathology of one hemisphere of the cerebellum). Unilateral dynamic ataxia is much more common.

Some of the symptoms of dynamic cerebellar ataxia overlap with those of static-locomotor ataxia. For example, this concerns the presence of cerebellar asynergies (Babinski asynergia lying and standing, Orzechowski and Stewart-Holmes tests). There is only a slight difference: since dynamic cerebellar ataxia is associated with damage to the cerebellar hemispheres, these tests predominate on the affected side (for example, if the left hemisphere of the cerebellum is damaged, “problems” will occur with the left extremities and vice versa).

Dynamic cerebellar ataxia also manifests itself:

• intention tremor (tremor) in the limbs. This is the name for trembling that occurs or intensifies towards the end of the movement being performed. At rest, no trembling is observed. For example, if you ask a patient to take a ballpoint pen from a table, then at first the movement will be normal, but by the time the pen is actually taken, the fingers will begin to tremble;
• missing and missing. These phenomena are the result of disproportionate muscle contraction: for example, the flexors contract more than necessary to perform a particular movement, and the extensors do not relax properly. As a result, it becomes difficult to perform the most common actions: bring a spoon to your mouth, fasten buttons, lace your shoes, shave, and so on;
• handwriting disorder. Dynamic ataxia is characterized by large, uneven letters and a zigzag direction of the writing;
• chanted speech. This term refers to the intermittency and jerkiness of speech, the division of phrases into separate fragments. The patient’s speech looks as if he were speaking from the podium with some slogans;
• nystagmus. Nystagmus is involuntary shaking movements of the eyeballs. Essentially, this is the result of incoordination of contraction of the eye muscles. The eyes seem to twitch, this is especially pronounced when looking to the side;
• adiadochokinesis. Adiadochokinesis is a pathological movement disorder that occurs in the process of rapid repetition of multidirectional movements. For example, if you ask a patient to quickly turn his palms against their axis (as if screwing in a light bulb), then with dynamic ataxia the affected hand will do this more slowly and awkwardly compared to the healthy one;
• pendulum-like nature of knee reflexes. Normally, a blow with a neurological hammer under the kneecap causes a single movement of the leg of varying degrees of severity. With dynamic cerebellar ataxia, the leg oscillates several times after one blow (that is, the leg swings like a pendulum).

To identify dynamic ataxia, it is customary to use a series of tests, since the degree of its severity does not always reach significant limits and is immediately noticeable. With minimal lesions of the cerebellum, it can only be detected by testing:

• finger-nose test. With the arm straightened and raised to a horizontal level with a slight abduction to the side, with eyes open and then with eyes closed, ask the patient to touch the nose with the tip of the index finger. If a person is healthy, he can do this without special labor. With dynamic cerebellar ataxia, the index finger misses, and when approaching the nose, an intention tremor appears;
• finger-finger test. With eyes closed, the patient is asked to touch each other with the tips of the index fingers of slightly spaced hands. Similar to the previous test, in the presence of dynamic ataxia, no hit occurs, trembling may be observed;
• finger hammer test. The doctor moves the neurological hammer in front of the patient’s eyes, and the patient must place his index finger exactly on the elastic band of the hammer;
• test with hammer A.G. Panova. The patient is given a neurological hammer in one hand and is asked to alternately and quickly squeeze the hammer with the fingers of the other hand, either by the narrow part (handle) or by the wide part (elastic band);
• heel-knee test. It is performed in a supine position. It is necessary to raise the straightened leg approximately 50-60°, hit the knee of the other leg with the heel and, as it were, “ride” the heel along the front surface of the shin to the foot. The test is carried out with eyes open and then with eyes closed;
• test for redundancy and disproportion of movements. The patient is asked to stretch his arms forward to a horizontal level with his palms up, and then, at the doctor’s command, turn his palms down, that is, make a precise 180° turn. In the presence of dynamic cerebellar ataxia, one of the arms rotates excessively, that is, more than 180°;
• test for diadochokinesis. The patient should bend his arms at the elbows and seem to take an apple in his hands, and then quickly make twisting movements with his hands;
• Doinikov finger phenomenon. In a sitting position, the patient places his relaxed hands on his knees, palms up. On the affected side, flexion of the fingers and rotation of the hand is possible due to an imbalance in the tone of the flexor and extensor muscles.

This a large number of tests for dynamic ataxia due to the fact that it is not always detected with only one test. It all depends on the extent of the damage to the cerebellar tissue. Therefore, for more in-depth analysis, several samples are usually carried out simultaneously.

Treatment of cerebellar ataxia

There is no single treatment strategy for cerebellar ataxia. It's connected with big amount possible reasons its occurrence. Therefore, first of all, it is necessary to establish that pathological condition(for example, stroke or multiple sclerosis), which led to cerebellar ataxia, and then a treatment strategy is built.

TO symptomatic remedies, most often used for cerebellar ataxia include:

• drugs of the Betagistine group (Betaserc, Vestibo, Westinorm and others);
• nootropics and antioxidants (Piracetam, Phenotropil, Picamilon, Phenibut, Cytoflavin, Cerebrolysin, Actovegin, Mexidol and others);
• drugs that improve blood flow (Cavinton, Pentoxifylline, Sermion and others);
• B vitamins and their complexes (Milgamma, Neurobeks and others);
• agents affecting muscle tone (Mydocalm, Baclofen, Sirdalud);
• anticonvulsants (Carbamazepine, Pregabalin).

Help in the fight against cerebellar ataxia is physical therapy and massage. Performing certain exercises allows you to normalize muscle tone, coordinate the contraction and relaxation of flexors and extensors, and also helps the patient adapt to new conditions of movement.

In the treatment of cerebellar ataxia, physiotherapeutic methods can be used, in particular electrical stimulation, hydrotherapy (baths), and magnetic therapy. Normalize speech disorders Sessions with a speech therapist will help.

In order to facilitate the process of movement, it is recommended for a patient with severe manifestations of cerebellar ataxia to use additional funds: canes, walkers and even wheelchairs.

In many ways, the prognosis for recovery is determined by the cause of cerebellar ataxia. So, in the presence of a benign cerebellar tumor after its surgical removal Maybe full recovery. Cerebellar ataxia associated with mild circulatory disorders and traumatic brain injuries, meningitis, and meningoencephalitis are successfully treated. Degenerative diseases and multiple sclerosis are less responsive to therapy.

Thus, cerebellar ataxia is always a consequence of some kind of disease, and not always neurological. Its symptoms are not so numerous, and its presence can be detected using simple tests. It is very important to install the real reason cerebellar ataxia in order to cope with the symptoms as quickly and effectively as possible. Patient management tactics are determined in each specific case.

Neurologist M. M. Shperling talks about ataxia:

Impaired Coordination - Ataxia. Treatment of Ataxia (doctor's recommendations).

The cerebellum, the center of higher coordination, and its first forms were formed in simple multicellular organisms that made voluntary movements. Fish and lampreys do not have a cerebellum as such: instead, these animals have flocculi and a vermiform - elementary structures that support simple coordination of the body.

In mammals, the cerebellum has a distinctive structure - a compaction of the lateral sections, which interacts with the cerebral cortex. In Homo Sapiens and its predecessors, the cerebellum has developed frontal lobes, which allows them to perform precise small manipulations, such as using a sewing needle, operating on appendicitis and playing the violin.

The human cerebellum is located in the hindbrain along with the pons. It is localized under the occipital lobes of the brain. Diagram of the structure of the cerebellum: left and right hemisphere, united by a worm - a structure that connects parts of the small brain and allows information to be exchanged between them.

The small brain consists of white (cerebellar body) and gray matter. Gray matter is the cortex. Foci of gray matter are localized in the thickness of the white matter, forming nuclei - a dense cluster nerve tissue, designed for specific functions.

The cerebellar tent is part of the hard meninges, which supports the occipital lobes and separates them from the cerebellum.

Nuclear topography of the cerebellum:

1. Serrated nucleus. It is located in lower parts white matter.
2. Tent core. Localized on the lateral side of the cerebellum.
3. Corky nucleus. It is located on the side of the dentate core, it runs parallel to it.
4. Globular nucleus. Outwardly they resemble small balls located next to the cork-like core.

Paired cerebellar arteries:

• Superior cerebellar.
• Inferoanterior cerebellar.
• Inferoposterior.

In 4-6%, the unpaired 4th artery occurs.

Functions of the cerebellum

The main function of the cerebellum is to adapt any movements. The embryos of the “small brain” are determined by three levels of the organ:

1. Vestibulocerebellum. The most ancient department from an evolutionary point of view. This area connects to the vestibular apparatus. It is responsible for the balance of the body and the joint coordination of the eyes, head and neck. The vestibulocerebellum ensures synchronous rotation of the head and eyes in response to a sudden stimulus.
2. Spinocerebellum. Thanks to connections with the spinal cord, from which the small brain receives information, the cerebellum controls the position of the body in space. The spinocerebellum controls muscle tone.
3. Neocerebellum. Connects with the cerebral cortex. The newest department is involved in the regulation and planning of movements of the arms and legs.

Other functions of the cerebellum:

• synchronization of the speed of movement of the left and right eyes;
• synchronous rotation of the body, limbs and head;
• calculation of movement speed;
• preparation and compilation of a motor program for performing higher manipulation skills;
• precision of movements;

Little-known functions:

1. regulation of the muscles of the speech apparatus;
2. mood regulation;
3. speed of thinking.

Symptoms

Cerebellar disorders:

Ataxia is an unnatural and unsteady gait in which the patient spreads his legs wide and balances with his arms. This is done to prevent falls. The patient's movements are uncertain. With ataxia, walking on heels or toes is impaired.

Dysarthria. Smoothness of movements is lost. With bilateral damage to the cerebellum, speech is impaired: it becomes sluggish, inarticulate, and slow. Patients repeat several times.

Adiadochokinesis. The nature of the affected functions depends on the location of damage to the structures of the small brain. With organic damage to the cerebral hemispheres, the amplitude, speed, strength and timeliness of movements (beginning and ending) are disrupted. The smoothness of movements is disrupted, the synergy between the flexor and extensor muscles is lost. Movements with adiadochokinesis are uneven and spasmodic. Muscle tone decreases. Initiation of muscle contraction is delayed. Often accompanied by ataxia.

Dysmetria. Pathology of the cerebellum manifests itself in the fact that the completion of an already started movement is disrupted. For example, when walking, a person moves both legs evenly. The patient’s leg may become “stuck” in the air.

Asthenia and dystonia. The muscles become rigid, and the tone in them is distributed unevenly. Dystonia is a combination of weakness of some muscles with hypertonicity of others. It is natural that in order to perform full movements the patient has to make great efforts, which increases the body’s energy consumption. The consequence is asthenia develops - pathological weakness in the muscles.

Intention tremor. Disruption of the cerebellum of this type leads to the development of tremor. Tremor comes in different forms, but cerebellar tremor is characterized by the fact that the arms and legs tremble at the end of movements. With the help of this sign it is carried out differential diagnosis between cerebellar tremor and tremors of the limbs with damage to the nuclei of the brain.

Combination of ataxia and dysmetria. Occurs when messages between the cerebellum and the motor centers of the cerebral cortex are damaged. The main symptom is the loss of the ability to complete a started movement. Towards the end of the final phase, trembling, uncertainty and unnecessary movements appear, which would help the patient correct his inaccuracies. Problems with the cerebellum at this level are identified using the knee-heel and finger-to-toe test. With eyes closed, the patient is asked to first touch the heel of one foot to the knee of the other, and then touch the tip of the nose with a finger. Typically, with ataxia and dysmetria, movements are uncertain, unsmooth, and the trajectory is zigzag.

Combination of asynergia, dysdiadochokinesia and dysarthria. A complex combination of disorders is characterized by a violation of complex motor acts and their synchrony. In later stages, such cerebellar neurology gives rise to speech disorder and dysarthria.

Some people mistakenly think that the cerebellum hurts in the back of the head. This is not so: pain sensations do not originate in the substance of the small brain, in the surrounding tissues, which are also involved in the pathological process.

Diseases and pathological conditions

Atrophic changes in the cerebellum

Signs of atrophy:

• headache;
• dizziness;
• vomiting and nausea;
• apathy;
• lethargy and drowsiness;
• hearing impairment; walking impairment;
• deterioration of tendon reflexes;
• ophthalmoplegia – a condition characterized by paralysis of the oculomotor nerves;
• speech impairment: it becomes inarticulate;
• trembling in the limbs;
• chaotic vibration of the eyeballs.

Dysplasia is characterized by improper formation of the substance of the small brain. Cerebellar tissue develops with defects that originate in fetal development. Symptoms:

1. difficulty performing movements;
2. tremor;
3. muscle weakness;
4. speech disorders;
5. hearing defects;
6. blurred vision.

The first signs appear in the first year of life. Symptoms are most pronounced when the child is 10 years old.

Cerebellar deformity

The cerebellum can be deformed for two reasons: tumor and dislocation syndrome. The pathology is accompanied by impaired blood circulation in the brain due to compression of the cerebellar tonsils. This leads to impaired consciousness and damage to vital regulatory centers.

Cerebellar edema

Due to the enlargement of the small brain, the outflow and inflow of cerebrospinal fluid is disrupted, which causes cerebral edema and stagnation of cerebrospinal fluid.

Signs:

• headache, dizziness;
• nausea and vomiting;
• disturbance of consciousness;
• fever, sweating;
• difficulty holding a pose;
• unsteadiness of walking, patients often fall.

When arteries are damaged, hearing is impaired.

Cerebellar cavernoma

Cavernoma is a benign tumor that does not spread metastases to the cerebellum. Severe headaches and focal neurological symptoms occur: impaired coordination and accuracy of movements.

It is a hereditary neurodegenerative disease accompanied by the gradual death of the cerebellar substance, which leads to progressive ataxia. In addition to the small brain, the pathways and brain stem are affected. Late degeneration appears after 25 years. The disease is transmitted in an autosomal recessive manner.

The first signs: unsteadiness of walking and sudden falls. Speech gradually deteriorates, muscles weaken and the spine becomes deformed like scoliosis. 10-15 years after the first symptoms, patients completely lose the ability to walk independently and need help.

Causes

Cerebellar disorders have the following causes:

• . The blood supply to the organ deteriorates.
• Hemorrhagic and ischemic stroke.
• Elderly age.
• Tumors.
• Injuries to the base of the skull and occipital region.

Diagnosis and treatment

Small brain diseases can be diagnosed using:

1. . The method detects hemorrhages into the substance, hematomas, tumors, birth defects and degenerative changes.
2. Lumbar puncture followed by examination of cerebrospinal fluid.
3. External neurological examination. Using an objective study, the doctor studies coordination of movements, stability of walking, and the ability to maintain a posture.

Cerebellar disorders are treated by addressing the underlying cause. For example, for infectious diseases, antiviral, antibacterial and anti-inflammatory drugs are prescribed. In addition to the main treatment, auxiliary therapy is provided: vitamin B complexes, angioprotectors, vasodilators and nootropic agents that improve microcirculation of the small brain substance.

If there is a tumor, surgery will be required on the cerebellum with a crossbow incision in the back of the head. The skull is trepanned, the superficial tissues are dissected, and the surgeon gains access to the cerebellum. In parallel to reduce intracranial pressure The ventricles of the brain are punctured.

1.Features of neurological examination of young children. Evolution of newborn reflexes. They begin with an examination, observing behavior during feeding, wakefulness and sleep, the position of the head, the shape of the skull, its size, the condition of the cranial sutures and fontanelles, facial expression, the position of the torso, limbs, spontaneous movements, the proportions of the torso and limbs. In N – fetal position, with muscular hypotonia the “frog” position, with inflammation of the meninges - the “kicking dog” position, with hemiparesis - asymmetrical arrangement of the limbs. Research f cranial nerves: 1 pair – to strong odors: closes eyelids, wrinkles face, screams. 2 pairs - light source causes: closing of eyelids. 3, 4,6 pairs – the size of the palpebral fissures. 5 pairs – observation. behind the act of sucking. 7th pair – the state of facial muscles during crying, sucking, screaming. 8 pairs – sound stimulus: closing eyelids, fear, change. breathing rhythm, turning the head. 9,10 – synchronization of the acts of sucking, swallowing and breathing. 11 – absent if damaged. turning the head in the opposite direction side, tilted heads back. 12 – position of the tongue in the mouth, its movement. The motor sphere is the volume of active and passive movements. in various positions - on the back, stomach, upright. position Unconditioned reflexes: segmental motor automatisms, provision. segments of the brain stem (oral: palmo-oral, proboscis, search Kussmaul, sucking) and spinal cord (spinal: protective, support, crawling, grasping, Moro), and suprasegmental posotonic automata, providing. regulation of muscle tone depending on the position of the body and head. Research over. feeling - light touch (in pathology - pain, screaming, anxiety). Assessing the level of mental development—observing visual and auditory reactions, making it possible to distinguish between loved ones.

2.Modern ideas about the organization of voluntary movement. Cortical-muscular tract—structure, functional significance. Central (upper) and peripheral (lower) motor neurons. Manufactured by adjusting the movement of the pyramidal system. With the help of the piram system, the individual will develop social life and professional motor skills. The anatomical basis of the mechanisms of voluntary movements is the cortico-muscular pathway - this is a purely effector pathway, consisting of 2 neurons: central and peripheral. The center of the body is located in the anterior-central gyrus, and the peripheral body is located in the peri-horns of the spinal cord and motor nuclei of the cranial nerves. The path from the motor cortex cells to the horn cells of the spinal cord is called pyramidal. To regulate the production movement of creatures, there are 2 systems: specific (pyramid) and nonspecific. The pyramid is a system of efferent fibers that moves the analysis. The part of the piram path going to the motor nuclei of the cranial nerves is an image of the corticonuclear path. The other part, going to the cells of the anterior horns of the spinal cord, constituted the corticonuclear pathway. Nonspecific (parapyramidal) refers to the sphere of reticular formation of the brain and provides the influence of an inhibitory or facilitating character, participating in the preparation of production movements and regulations. Cortico-muscular path: 1st neuron V layer of the cortex precentral gyrus Betz cells → descend as part of the corona radiata → approach the internal capsule → corticospinal part passage through the anterior 2/3 of the posterior peduncle, and corticonuclear through knee internal capsule →descend into the medulla (corticospinal) →in the lower part of the medulla the corticospinal path makes an incomplete decussation (passes into the lateral cord of the spinal cord of the opposite side, a smaller part of 10% remains in the anterior cord (Bundle of Turk) of its side )→ fibers to the 2nd neuron, located in the anterior horns of the spinal cord. Cortico-nuclear after the internal capsule → into the nuclei of the cranial nerves. Types of motor neurons: alpha large - white muscles, alpha small - red muscles (these 2 motor neurons of the horns of the spinal cord), gamma are associated with the reticular formation and affect the excitability of the nerves mouse spindles and maintaining muscle tone.

3. Corticospinal tract. Its functional significance for the organization of voluntary movements. 1st neuron V layer of cortex precentral gyrus Betz cells → descend as part of the corona radiata → approach the internal capsule → pass through the anterior 2/3 of the posterior leg → descend into the medulla → in the lower part of the medulla make an incomplete decussation (turns into lateral cord of the spinal cord on the opposite side, a smaller part of 10% remains in the anterior cord (Bundle of Turk) on its side) → fibers to the 2nd neuron, which are found in the anterior horns of the spinal cord (in the gray part).

4.Reflex arc. Structure, functioning, regulation of muscle tone. Gamma system. Suprasegmental levels of muscle tone regulation. A reflex arc is the path traversed by a nerve impulse during a reflex. Reflexes of cases: unconditional and conditional. Unconditional reflexes are under direct and indirect control of the cortex. The scheme of the unconditioned reflex is considered based on the knee reflex: hitting the lig with the hammer. patellae excites the receptors of this tendon, as well as the receptors of the quadriceps muscle itself. The flow of afferent impulses through the femoral nerve, intervertebral ganglion and dorsal root enters the dorsal horn, then switching to the anterior horn, from the cat along the anterior roots and moves the fibers of the femoral nerve into the same quadriceps muscle, causing it to contract. Muscle tone is a reflexive muscle tension that provides preparation for performing movements, maintaining balance and posture, and the ability of muscles to resist stretching. There are 2 components: muscle tone itself, which depends on the specific metabolic processes occurring in it and neuromuscular tone (reflex), which is caused by muscle stretching, i.e. irritation of proprioceptors and determined by nerve impulses, the cat reaches this muscle. The tonic r-th is based on the stretch reflex, the arc of the cat closes in the spinal cord.

5.Central and peripheral paresis– changes in muscle tone, reflexes, muscle trophism. When the first and second motor neurons are damaged, they develop corresponding central and peripheral paralysis, or (only by reducing the volume and strength of movement) central and peripheral paresis. The symptoms of central and peripheral paresis have one common feature - it is impossible to make voluntary movements or difficulty in performing movements due to weakness in the limbs. Symptoms of central paralysis, which occurs when the central motor neuron is damaged at any level (precentral gyrus, internal capsule, brain stem, spinal cord): 1. mouse tone - mouse hypertension; 2. tendon and periosteal reflexes – hyperreflexia; 3. rhythmic, long-lasting contractions – clonus; 4. pathologist reflexes (extensor: extension of the thumb when striking strokes along the edge of the sole - Babinsky, along the middle part of the shin - Oppenheim, when squeezing the calf muscle - Gordon; flexion: reflex flexion of the fingers or toes in response to a short blow along their pads - Rossolimo, along the back of the hand or foot - Bekhterev, along the middle of the sole or palm - Zhukovsky); 5. defense reflexes; 6. synkinesis - involuntary movements in paralyzed limbs, observed in response to some purposeful or involuntary movement; 7. adductor symtoms - bringing paralysis of the leg during percussion along the crest of the iliac bone (Razdolsky's method). S-we peripheral or flaccid paralysis, arose when the peripheral motor neuron is damaged at any level (motoneurons of the trunk or spinal cord, anterior roots, plexuses, nerves): 1. loss or ↓ mouse tone - atony or hypotonia; 2. absence or ↓ tendon refs – areflexia or hyporeflexia; 3. muscle nutrition - mouse atrophy; 4. nar electrical excitability.

6. Clinical features of damage to the cortical-muscular tract on different levels– cerebral cortex, internal capsule, brain stem, anterior root, peripheral nerve, synapse, muscle. Cortico-muscular path: 1st neuron V layer of the cortex precentral gyrus Betz cells → descend as part of the corona radiata → approach the internal capsule → corticospinal part passage through the anterior 2/3 of the posterior peduncle, and corticonuclear through knee internal capsule →descend into the medulla (corticospinal) →in the lower part of the medulla the corticospinal path makes an incomplete decussation (passes into the lateral cord of the spinal cord of the opposite side, a smaller part of 10% remains in the anterior cord (Bundle of Turk) of its side )→ fibers to the 2nd neuron, located in the anterior horns of the spinal cord. Corticonuclear after the internal capsule → into the nuclei of the cranial nerves. Lesions: 1. cortex – loss of f (central paralysis on the opposite side) or irritation (Jacksonian epilepsy); 2. internal capsule – central hemiparesis on the opposite sex side; 3. brainstem – alternating paralysis – nar f of the cranial nerve on the affected side and the center of hemiplegia on the opposite side; 4. anterior root – atrophic paralysis on the affected side; 5. peripheral nerve – movement disorders, loss of sensation in the zone of innervation of the affected nerve.

7.Structure and main connections of the extrapyramidal system. Participation in the organization of movements, muscle tone, stereotypical automated movements, emotions. Extrapyramidal system including: striatal, palidar systems and cerebellum. They act extrapiram systems - we regulate the bark. In the extrapyramidal cortex, the system is represented predominantly in the frontal lobe. At the level of the segmental apparatus of the spinal cord, extrapyramidal influences are realized by alpha small and gamma motor neurons. The striopalidal system is divided into: striatum (caudate nucleus, putamen) and pallidum (globus pallidus, substantia nigra, red and subthalamic nuclei). From the cortex to the extrapyramidal system there are powerful cortico-pallidal and cortico-nigral pathways. With their help, the extrapirate system was connected to every voluntary movement. Bilateral connections between the cortex, extrapyramis sis and thalamus - ring-shaped neural circles - make it possible to combine these images to perform a variety of movements. All impulses entering the striopallidum are concentrated mainly in the globus pallidus and substantia nigra, from where a bundle of efferent fibers originates, directing to the red nucleus, the reticulum of the trunk formation, the tubercle, the quadrigeminal, and the vestibular nuclei. Pathways: 1. red nucleus-spinal (red nucleus → lateral cords); 2. reticulospinal (nuclei of the reticulum formation → anterior cords); 3. vestibulospinal; 4. tectospinal. The extrapyram system provides complex automated movements (movement, swimming), maintaining muscle tone, redistributing it during movements, maintaining the segmental apparatus in readiness for action, participating in start reflexes and facial expressive movements.

8.Striatal system lesion syndrome. Types of hyperkinesis. Examples of diseases. When the striatum is damaged - ↓ mouse tone, hyperkinesis (hypotonic hyperkinetic syndrome). Hyperkinesis – violent, automatic movements that interfere with the performance of voluntary movements. Types: 1. athetosis – slow worm-like movements in the distal limbs and facial muscles; 2. torsion dystonia – violent, corkscrew-like turns of the torso, neck muscles, proximal limbs around its axis; 3. tremor = tremor; 4. myoclonus – random contraction of various muscle groups, fast pace, small in amplitude; 5. choreic hyperkinesis – erratic, involuntary movement in various parts of the body; 6. tics; 7. hemiballism – compared to the flapping of a wing. Obstacles: Gilles de la Tourette's disease – tics become generalized, increasing + vocal manifestations. Minor chorea = rheumatic chorea - triad: choreic hyperkinesis, hypotension, emotional status disorders (tearfulness, irritability, sleep disorders).

9/Syndrome of pallido-nigral system lesion. Examples of disease. With damage to the palidar system - hypertensive hypokinetic syndrome (tone, slow movements) - sm parkinsonism. Manifestations: 1. oligokinesia (small motor active); 2. bradykinesia (stiffness and slowness when performing productive movements); 3. oligo- and bradypsychia; 4. bending pose; 5. gear wheel (increases muscle tone); 6. rest tremor – counting coins; 7. air cushion sm; 8. the face has a mask-like appearance, the gaze is motionless, poor gestures; 9. micrography; 10. scanned speech (the patient abruptly breaks off the syllables).

10.Anatomy and f of the cerebellum. Afferent and efferent connections. The cerebellum is located in the posterior cranial fossa between the hemispheres and the brain stem. Consists of 2 plusharia and a worm. The vermis is primarily important for static coordination, and the hemispheres for dynamic coordination. The cerebellum has a cortex (gray nucleus), white nucleus and a group of nuclei, the most important of which are the dentate nucleus and the tent nucleus. Cellular accumulations form molecules and granular layers, and the cat contains a layer of piriform neurons (Purkinje cells). The cerebellum has 3 pairs of legs, the fibers form numerous afferent and efferent pathways. The arm is represented in the anterior parts of the hemispheres, the leg is in the posterior, in the medulla there are centers for the proximal parts of the limb, and in the lateral part - for the distal ones. In the region of the upper part of the worm the head and neck are represented, in the lower part and tonsils - the torso and some proximal segments of the limbs. The following afferent pathways pass through the inferior cerebellar peduncle: 1. posterior spinocerebellar (Flexig's bundle) impulses from the muscles, ligaments, tendons → vermis; 2. vestibulocerebellar tract, connecting the vestibular apparatus with the vermis; 3. olivocerebellar – the inferior olive is connected to the cerebellar cortex; 4. a bundle from the nuclei of the posterior funiculi (Gaull and Burdach), from which the cat enters the worm and deeply senses the signals. As part of the lower leg, the efferent path passes from the nucleus of the tent to the reticulum formation and the vestibular nuclei. Through the middle cerebellar peduncles there are 2 efferent pathways: fronto-pontine-cerebellar and occipito-temporo-cerebellar. In the superior cerebellar peduncles: the efferent pathway is the dentate-rednuclear-spinal cord. It starts from the dentate nucleus of the cerebellum, goes to the opposite red nucleus (Wernekin's decussation), after which its fibers make a second crossing in the midbrain (Forel's decussion) and descends to the sides of the cords of the spinal cord, ending at the cells of the anterior horns. The afferent pathway is the anterior spinocerebellar tract or Govers' bundle. The anatomist is special - 2 decussations: in the spinal cord and in the forebrain region of the velum.

11. Symptoms and syndromes of damage to the hemispheres and cerebellar vermis. Research methods.

One of the main causes of cerebellar damage is ataxia. When the worm is affected - static, when the hemispheres are affected - dynamic. Static – the patient sways while walking and standing, and compensates for this by spreading his legs wide apart. When the front part of the worm is affected, the patient falls forward, and the back part falls backward. Dynamic – disorders on his side, the patient sways when walking, predominantly in the affected direction, intention tremor, horizontal nystagmus, dysmetria (the patient does not bring the limb to the target or moves it excessively beyond the target), adiadochokinesis (the patient is capable of simultaneously producing the opposite movement), with -lack of reverse impulse, macrographia, underestimation of severity, muscle hypotonia. Research methods - tests: Romberg, Stewart-Holmes (for the absence of a reverse push), asynergia is revealed by the Babinsky test - the patient sits up from a horizontal position with the help of his hands, while raising his legs at an angle, test for adiodochokinesis (twisting light bulbs), etc.

12. Types of ataxia. Clinical examples. Cerebellar ataxia (Friedreich, Pierre Marie ataxia): When the vermis is affected - static, when the hemispheres are affected - dynamic. Static – the patient sways while walking and standing, and compensates for this by spreading his legs wide apart. When the front part of the worm is affected, the patient falls forward, and the back part falls backward. Dynamic - disorders on his side, the patient sways when walking, predominantly in the affected direction, intention tremor, horizontal nystagmus, dysmetria (the patient does not bring the limb to the target or excessively moves it beyond the target), adiadochokinesis (the patient is capable of simultaneously producing the opposite movement), with -lack of reverse impulse, macrographia, underestimation of severity, muscle hypotonia. Sensitive ataxia: unsteady gait associated with a violation of the proceptive senses and loss of awareness of the position of body parts in space (muscle-joint senses). Observation of damage to the posterior columns of the spinal cord. Vision control reduces unsteadiness and uncertainty in walking. When the pathologist involved the process of the Burdach bundle, there was a violation of the coordination mainly in the upper extremity, a miss when performing the finger-nose test, movements in the hands became awkward, and pseudoathetosis appeared (out of control for the positional extremity). Vestibular ataxia: when the vestibules of the analyzer are affected, balance is lost, an unsteady gait appears, attacks of systemic dizziness, nausea and vomiting, and autonomic disorders appear. Patients do not tolerate travel well and are subject to seasickness and air sickness. Frontal ataxia: unsteadiness when walking, associated with damage to the frontal-pontine-cerebellar tract. Accompanied by lateropulsion (involuntary deviation of the body to the side after a slight, light push from the opposite side) in the opposite direction from the lesion. + symptoms characteristic of damage to the frontal lobes of the brain. Hysterical ataxia.

13. Classification of types of sensitivity. Quantitative and qualitative sensitivity disorders. Sensitivity is divided into: general and associated with the senses; The general sense is divided into: A) superficial = contact = extroceptive; B) deep = proprioceptive; C) interoceptive. Superficial is divided into: 1. simple – painful, tactile, temperature; 2. complex – sense of localization, discriminatory feeling (using a special compass), two-dimensional-spatial (we draw on the skin). Deep is divided into: 1. simple – muscular-articular feeling, feeling of vibration, pressure, weight; 2. deep – stereognosis (recognition of objects by touch). Quantitative races: 1. anesthesia - complete or total loss of sensations. Half the body - hemianesthesia, one limb - monoanesthesia; 2. hyposthesia – ↓ feeling; 3. hyperesthesia – Chuv. Loss of painful sensations: 1. analgesia – loss of painful sensations; 2. thermoanesthesia – loss of temperature; 4. anesthesia – loss of tactile sensation. Qualitative disorders: 1. allocheiria - nar, when the patient localizes the irritation not in the place where it is applied, but on the opposite half of the body; 2. dysesthesia - perverted perception of the stimulus (warmth, like cold); 3. paresthesia - a feeling of burning, tingling, tightening, without visible external influences; 4. pain symptoms– occur when the pathological process is localized in the area of ​​receptors, in peripheral nerves, plexuses, dorsal roots, optic thalamus, and posterior central gyrus.

14. Types of sensitivity disorders - peripheral, segmental, conduction, cortical. Dissociated sensory disorder. Syringomyelitic syndrome. Peripheral disorders may be in the receptor zone (local), with damage to one nerve or plexus (mononeuritic) - sensitivity in all types; with multiple lesions of peripheral nerves (polyneuritic) - like socks, stockings, gloves. Segmental disorder: 1. damage to the ganglia - all types of sensitivity suffer + herpetic rashes; 2. when the back of the roots is affected, there is a sensation in the form of stripes on the affected side, longitudinal stripes on the end (stripes), on the torso – transverse, on the buttocks – circular + pain. Spinal disorders - loss of deep sensitivity, muscle-joint senses and sensory ataxia: 1. with damage to the dorsal horns or anterior commissure of the spinal cord - dissociated nar with localization in the dorsal horns on the affected side, and with localization in the commissure - on both sides . Dissociation involves the loss of surface sensations (pain and temperature), while maintaining deep and tactile ones. 2. damage to the lateral cord - pain and temperature are felt on the opposite side, deep on the affected side. In case of half damage to the spinal cord (Brown-Séquard syndrome) - deep on the same side, superficial on the opposite side + center paralysis on the same side. With damage to the internal capsule - hemianesthesia, hemiplegia, hemianopsia (3 hemi syndrome). Posterior central gyrus: irritation - paresthesia (local on the opposite side), loss - monoesthesia (local on the opposite side). Syringomyelitic syndrome. Syringomyelia manifests itself at the age of 20, with lesions in the dorsal horns of the spinal cord. Observe segmental unilateral sensations of temperature and pain in the area of ​​the chest, torso, and limbs (the zone of lower feelings in the form of a jacket). Their hands were covered in burns and paresis, and the patients didn’t even pay attention to the cat.

15. Sensory damage syndrome depending on the level of damage - cortex, internal capsule, brain stem, spinal cord, peripheral nerves. Cortex: Posterior central gyrus: irritation - paresthesia (local on the opposite side), loss - monoesthesia (local on the opposite side). Internal capsule: hemianesthesia, hemiplegia, hemianopsia (3 hemi syndrome). Brainstem - alternating syndromes (crossover) - symptomatic complex SYMPTOMOCOMPLEX C, characterized by dysfunction of the cranial nerves on the side of the lesion and disorder DISORDER- 1. Violation of the structure, the order of building something. 2. Causing damage to anything; impairment on the opposite side of the body motor PARESIS(Greek paresis - weakening). Decrease in the strength and (or) amplitude of active movements in communication, conduction, sensory and coordination functions. Spinal cord: 1. with damage posterior horns or the anterior commissure of the spinal cord - dissociated with localization in the dorsal horns on the affected side, and with localization in the commissure - on both sides. Dissociation involves the loss of surface sensations (pain and temperature), while maintaining deep and tactile ones. 2. damage to the lateral cord - pain and temperature are felt on the opposite side, deep on the affected side. In case of half damage to the spinal cord (Brown-Séquard syndrome) - deep on the same side, superficial on the opposite side + center paralysis on the same side. Peripheral disorders may be in the receptor zone (local), with damage to one nerve or plexus (mononeuritic) - sensitivity in all types; with multiple lesions of peripheral nerves (polyneuritic) - like socks, stockings, gloves.

16. Pain (local, referred, projection, phantom, causalgia). Pain points. Symptoms of tension in nerve trunks. Local pain – occurs in the area where the painful stimulus is applied. Referred pain is localized by the Zakharyin-Ged zones and occurs in diseases of the internal organs. Projection pain – when the nerve trunk is irritated, it is projected into the skin area innervated by the nerve. Phantom pain – after limb amputation. Causalgia is paroxysmal pain of a burning nature, aggravated by touch, excitement and localized in the area of ​​the affected nerve. C-we tension - determined by damage to the dorsal roots, plexuses and trunks of peripheral nerves. S-Lasegue - pain when the sciatic nerve is stretched. S-Neri – bending the head forward causes pain in the lower back. S-Sekara - sharp dorsiflexion of the foot causes pain along the sciatic nerve. Matskevich's syndrome - pain when the femoral nerve is stretched, on the stomach, flexion of the leg at the knee joint, pain in the anterior region. Wasserman’s exercise – on the stomach, we raise the straight leg, pain along the front surface of the thigh. Erb's point - located 2 cm above the middle of the clavicle, pain in the brachial plexus. Gar's points - with damage to the lumbosacral plexus, paravertebral points in the lumbar region. Walle's points - at the point where the sciatic nerve exits the pelvic cavity, in the area of ​​the gluteal fold, in the middle part of the popliteal fossa, posterior to the head of the fibula, in the middle of the gastrocnemius muscle, posterior to the inner malleolus.

Cerebellar ataxia is a syndrome that occurs when a special structure of the brain called the cerebellum or its connections to other parts of the nervous system are damaged. Cerebellar ataxia is very common and can be the result of a wide variety of diseases. Its main manifestations are a disorder of coordination of movements, their smoothness and proportionality, disturbance of balance and maintenance of body posture. Some signs of cerebellar ataxia are visible to the naked eye even to a person without medical education, while others are detected using special tests. Treatment of cerebellar ataxia largely depends on the cause of its occurrence, on the disease from which it is a consequence. You will learn about what can cause cerebellar ataxia, what symptoms it manifests and how to deal with it by reading this article.

The cerebellum is a part of the brain located in the posterior cranial fossa below and behind the main part of the brain. The cerebellum consists of two hemispheres and the vermis, the middle part that connects the hemispheres with each other. The average weight of the cerebellum is 135 g, and its size is 9-10 cm × 3-4 cm × 5-6 cm, but despite such small parameters, its functions are very important. None of us thinks about what muscles need to be tensed in order, for example, to simply sit down or stand up, or take a spoon in our hand. It seems to happen automatically, you just have to want it. However, in fact, to perform such simple motor acts, the coordinated and simultaneous work of many muscles is necessary, which is only possible with the active functioning of the cerebellum.

The main functions of the cerebellum are:

• maintaining and redistributing muscle tone to keep the body in balance;
• coordination of movements in the form of their accuracy, smoothness and proportionality;
• maintenance and redistribution of muscle tone in synergist muscles (performing the same movement) and antagonist muscles (performing multidirectional movements). For example, to bend a leg, you must simultaneously tense the flexors and relax the extensors;
• economical use of energy in the form of minimal muscle contractions necessary to perform a specific type of work;
• participation in motor learning processes (for example, the formation of professional skills associated with the contraction of certain muscles).

If the cerebellum is healthy, then all these functions are carried out unnoticed by us, without requiring any thought processes. If any part of the cerebellum or its connections with other structures is affected, then the performance of these functions becomes difficult and sometimes simply impossible. This is when the so-called cerebellar ataxia occurs.

The spectrum of neurological pathology occurring with signs of cerebellar ataxia is very diverse. The causes of cerebellar ataxia can be:

• disorders of cerebral circulation in the vertebrobasilar region (and discirculatory encephalopathy);
• and cerebellopontine angle;
• with damage to the cerebellum and its connections;
• , meningoencephalitis;
• degenerative diseases and anomalies of the nervous system with damage to the cerebellum and its connections (, and others);
• intoxication and metabolic damage (for example, alcohol and drug use, lead intoxication, diabetes mellitus, and so on);
• overdose of anticonvulsants;
• vitamin B12 deficiency;
• obstructive.

Symptoms of cerebellar ataxia

It is customary to distinguish two types of cerebellar ataxia: static (static-locomotor) and dynamic. Static cerebellar ataxia develops with damage to the cerebellar vermis, and dynamic ataxia develops with pathology of the cerebellar hemispheres and its connections. Each type of ataxia has its own characteristics. Cerebellar ataxia of any type is characterized by a decrease in muscle tone.

Static-locomotor ataxia

This type of cerebellar ataxia is characterized by a violation of the antigravity function of the cerebellum. As a result, standing and walking become too much of a strain on the body. Symptoms of static-locomotor ataxia may include:

• inability to stand straight in the “heels and toes together” position;
• falling forward, backward or swaying to the sides;
• the patient can stand only by spreading his legs wide apart and balancing with his hands;
• unsteady gait (like a drunk);
• when turning, the patient “slides” to the side, and he may fall.

To identify static-locomotor ataxia, several simple tests are used. Here are some of them:

• standing in the Romberg pose. The pose is as follows: toes and heels pushed together, arms extended forward to a horizontal level, palms facing down with fingers spread wide. First, the patient is asked to stand with his eyes open, and then with his eyes closed. With static-locomotor ataxia, the patient is unstable both with his eyes open and with his eyes closed. If no deviations are detected in the Romberg position, then the patient is asked to stand in a complicated Romberg position, when one leg must be placed in front of the other so that the heel touches the toe (maintaining such a stable position is possible only in the absence of pathology on the part of the cerebellum);
• the patient is asked to walk along a conventional straight line. With static-locomotor ataxia, this is impossible; the patient will inevitably deviate in one direction or another, spread his legs wide apart, and may even fall. They are also asked to stop abruptly and turn 90° to the left or right (with ataxia the person will fall);
• The patient is asked to walk with a side step. Such a gait with static-locomotor ataxia becomes as if dancing, the torso lags behind the limbs;
• "star" or Panov test. This test allows you to identify disorders in mildly expressed static-locomotor ataxia. The technique is as follows: the patient needs to successively take three steps forward in a straight line, and then three steps back, also in a straight line. First, the test is carried out with open eyes, and then with closed ones. If with open eyes the patient is even more or less able to perform this test, then with closed eyes he inevitably turns around (a straight line does not come out).

In addition to impaired standing and walking, static-locomotor ataxia manifests itself as a violation of coordinated muscle contraction when performing various movements. This is called in medicine cerebellar asynergies. Several tests are also used to identify them:

• the patient is asked to sit up sharply from a lying position with his arms crossed over his chest. Normally, the muscles of the trunk and the posterior group of thigh muscles contract synchronously, and the person is able to sit down. With static-locomotor ataxia, synchronous contraction of both muscle groups becomes impossible, as a result of which it is impossible to sit without the help of hands, the patient falls back and one leg rises at the same time. This is the so-called Babinski asynergy in the supine position;
• Babinsky's synergy in a standing position is as follows: in a standing position, the patient is asked to bend back, throwing back his head. Normally, for this, a person will have to involuntarily bend his knees slightly and straighten his hip joints. With static-locomotor ataxia, neither flexion nor extension occurs in the corresponding joints, and an attempt to bend ends in a fall;
• Orzechowski's test. The doctor extends his hands, palms up, and invites the standing or sitting patient to rest his palms on them. Then the doctor suddenly moves his hands down. Normally, the patient's lightning-fast, involuntary muscle contractions cause him to either lean back or remain motionless. This will not work for a patient with static-locomotor ataxia - he will fall forward;
• phenomenon of absence of reverse shock (positive Stewart-Holmes test). The patient is asked to forcefully bend his arm at the elbow joint, and the doctor counteracts this, and then suddenly stops the opposition. With static-locomotor ataxia, the patient's hand is thrown back with force and hits the patient's chest.

Dynamic cerebellar ataxia

In general, its essence lies in the disruption of smoothness and proportionality, accuracy and dexterity of movements. It can be bilateral (with damage to both hemispheres of the cerebellum) and unilateral (with pathology of one hemisphere of the cerebellum). Unilateral dynamic ataxia is much more common.

Some of the symptoms of dynamic cerebellar ataxia overlap with those of static-locomotor ataxia. For example, this concerns the presence of cerebellar asynergies (Babinski asynergia lying and standing, Orzechowski and Stewart-Holmes tests). There is only a slight difference: since dynamic cerebellar ataxia is associated with damage to the cerebellar hemispheres, these tests predominate on the affected side (for example, if the left hemisphere of the cerebellum is damaged, “problems” will occur with the left extremities and vice versa).

Dynamic cerebellar ataxia also manifests itself:

• intention tremor (tremor) in the limbs. This is the name for trembling that occurs or intensifies towards the end of the movement being performed. At rest, no trembling is observed. For example, if you ask a patient to take a ballpoint pen from a table, then at first the movement will be normal, but by the time the pen is actually taken, the fingers will begin to tremble;
• missing and missing. These phenomena are the result of disproportionate muscle contraction: for example, the flexors contract more than necessary to perform a particular movement, and the extensors do not relax properly. As a result, it becomes difficult to perform the most common actions: bring a spoon to your mouth, fasten buttons, lace your shoes, shave, and so on;
• handwriting disorder. Dynamic ataxia is characterized by large, uneven letters and a zigzag direction of the writing;
• chanted speech. This term refers to the intermittency and jerkiness of speech, the division of phrases into separate fragments. The patient’s speech looks as if he were speaking from the podium with some slogans;
• nystagmus. Nystagmus is involuntary shaking movements of the eyeballs. Essentially, this is the result of incoordination of contraction of the eye muscles. The eyes seem to twitch, this is especially pronounced when looking to the side;
• adiadochokinesis. Adiadochokinesis is a pathological movement disorder that occurs in the process of rapid repetition of multidirectional movements. For example, if you ask a patient to quickly turn his palms against their axis (as if screwing in a light bulb), then with dynamic ataxia the affected hand will do this more slowly and awkwardly compared to the healthy one;
• pendulum-like nature of knee reflexes. Normally, a blow with a neurological hammer under the kneecap causes a single movement of the leg of varying degrees of severity. With dynamic cerebellar ataxia, the leg oscillates several times after one blow (that is, the leg swings like a pendulum).

To identify dynamic ataxia, it is customary to use a series of tests, since the degree of its severity does not always reach significant limits and is immediately noticeable. With minimal lesions of the cerebellum, it can only be detected by testing:

• finger-nose test. With the arm straightened and raised to a horizontal level with a slight abduction to the side, with eyes open and then with eyes closed, ask the patient to touch the nose with the tip of the index finger. If a person is healthy, he can do this without much difficulty. With dynamic cerebellar ataxia, the index finger misses, and when approaching the nose, an intention tremor appears;
• finger-finger test. With eyes closed, the patient is asked to touch each other with the tips of the index fingers of slightly spaced hands. Similar to the previous test, in the presence of dynamic ataxia, no hit occurs, trembling may be observed;
• finger hammer test. The doctor moves the neurological hammer in front of the patient’s eyes, and the patient must place his index finger exactly on the elastic band of the hammer;
• test with hammer A.G. Panova. The patient is given a neurological hammer in one hand and is asked to alternately and quickly squeeze the hammer with the fingers of the other hand, either by the narrow part (handle) or by the wide part (elastic band);
• heel-knee test. It is performed in a supine position. It is necessary to raise the straightened leg approximately 50-60°, hit the knee of the other leg with the heel and, as it were, “ride” the heel along the front surface of the shin to the foot. The test is carried out with eyes open and then with eyes closed;
• test for redundancy and disproportion of movements. The patient is asked to stretch his arms forward to a horizontal level with his palms up, and then, at the doctor’s command, turn his palms down, that is, make a precise 180° turn. In the presence of dynamic cerebellar ataxia, one of the arms rotates excessively, that is, more than 180°;
• test for diadochokinesis. The patient should bend his arms at the elbows and seem to take an apple in his hands, and then quickly make twisting movements with his hands;
• Doinikov finger phenomenon. In a sitting position, the patient places his relaxed hands on his knees, palms up. On the affected side, flexion of the fingers and rotation of the hand is possible due to an imbalance in the tone of the flexor and extensor muscles.

Such a large number of tests for dynamic ataxia is due to the fact that it is not always detected with only one test. It all depends on the extent of the damage to the cerebellar tissue. Therefore, for more in-depth analysis, several samples are usually carried out simultaneously.

Treatment of cerebellar ataxia

There is no single treatment strategy for cerebellar ataxia. This is due to a large number of possible reasons for its occurrence. Therefore, first of all, it is necessary to establish the pathological condition (for example, stroke or multiple sclerosis) that led to cerebellar ataxia, and then a treatment strategy is developed.

The symptomatic remedies most often used for cerebellar ataxia include:

Help in the fight against cerebellar ataxia is physical therapy and massage. Performing certain exercises allows you to normalize muscle tone, coordinate the contraction and relaxation of flexors and extensors, and also helps the patient adapt to new conditions of movement.

In the treatment of cerebellar ataxia, physiotherapeutic methods can be used, in particular electrical stimulation, hydrotherapy (baths), and magnetic therapy. Sessions with a speech therapist will help normalize speech disorders.

In order to facilitate the process of movement, a patient with severe manifestations of cerebellar ataxia is recommended to use additional means: canes, walkers and even wheelchairs.

In many ways, the prognosis for recovery is determined by the cause of cerebellar ataxia. Thus, in the presence of a benign cerebellar tumor, complete recovery is possible after its surgical removal. Cerebellar ataxia associated with mild circulatory disorders and traumatic brain injuries, meningitis, and meningoencephalitis are successfully treated. Degenerative diseases and multiple sclerosis are less responsive to therapy.

Thus, cerebellar ataxia is always a consequence of some kind of disease, and not always neurological. Its symptoms are not so numerous, and its presence can be detected using simple tests. It is very important to establish the true cause of cerebellar ataxia in order to cope with the symptoms as quickly and effectively as possible. Patient management tactics are determined in each specific case.

Neurologist M. M. Shperling talks about ataxia:

The cerebellum is a component of the brain that is located in the posterior cranial fossa. Towers over him medulla and bridge. The cerebellum is separated from the occipital lobes of the brain by the tentorium, or in other words, by the tent. The tentorium is represented by a process of the dura mater of the brain. The cerebellum can connect to the brain stem - the department that is responsible for all vital functions of the body, such as breathing and heartbeat - thanks to the 3 legs that connect it to the brain stem.

At birth, the mass of the cerebellum is approximately 5% of the total body mass, about 20 g. But with age, the volume of the cerebellum increases, and by 5 months the mass increases 3 times, and by 9 months it is approximately 4 times the original. In humans, by the age of 15, the cerebellum stops increasing in size and weighs approximately 150 g. The cerebellum has a similar structure to the cerebral hemispheres. It is even called the “little brain.” There are two surfaces in it:

• Upper;
• Bottom.

And also two edges:

• Front;
• Rear.

The cerebellum has 3 sections:

• Ancient – ​​hook;
• The old one is the vermis, which is located in the midline of the cerebellum;
• New - hemispheres, which are 2 in number, are located on the sides of the worm and imitate the hemispheres of the cerebrum. In evolutionary terms, this is the most developed structure of the cerebellum. Each hemisphere is divided into 3 lobes by grooves, with each lobe corresponding to a specific section of the worm.

Like the brain, the cerebellum has gray and white matter. Gray makes up the cortex, and white makes up the fibers, with the cerebellar nuclei located inside - globular, dentate, tegmental. These nuclei play an important role in the conduction of nerve pathways that do not cross in their path, or cross twice, which leads to the localization of signs of the disorder on the affected side. Nerve impulse, running through the cerebellar nuclei, is necessary for the cerebellum to perform its functions:

• Coordination of movements, their proportionality and smoothness;
• Maintaining body balance;
• Regulation of muscle tone, its redistribution and maintenance, which ensures adequate performance of the functions assigned to the muscles;
• Providing a center of gravity;
• Synchronization of movements;
• Anti-gravity.

Each of these functions plays a big role in a person’s life. When these functions are lost or impaired, characteristic symptoms appear that unite general term"cerebellar syndrome". This syndrome is characterized by disorders of a vegetative nature, motor sphere, and muscle tone, which cannot but affect the patient’s quality of life. One of components syndrome is ataxia.

Cerebellar ataxia

Ataxia is a disorder of coordination and motor function. This manifests itself in the form of disturbances in movement, gait and balance. Ataxia is accompanied by another group of symptoms specific to it. If they appear in a stationary position, then we are talking about static ataxia, if during movement, then about dynamic. Ataxia has many forms and occurs in a wide variety of diseases. Separately, cerebellar ataxia is distinguished, which is associated with pathological processes cerebellum.

In neurological practice, it is customary to divide cerebellar ataxia into the following types, depending on the nature of the process:

• Acute onset;
• Subacute onset (from 7 days to several weeks);
• Chronic progressive (developing over several months or years) and episodic (paroxysmal).

Cerebellar lesions that lead to the development of ataxia can be either congenital, genetically programmed, or acquired. The main causative factors of this disease are:

• Ischemic stroke caused by blockage of an artery with an atherosclerotic plaque, embolus or any other foreign body;
• Hemorrhagic stroke;
• Trauma as a consequence of traumatic brain injury;
• Intracerebral hematoma, which led to compression of intracerebellar structures;
• Multiple sclerosis;
• Guillain's syndrome;
• Inflammatory diseases of the brain – encephalitis;
• Obstructive hydrocephalus is dropsy of the brain caused by blockage of brain structures;
• Acute intoxications of various origins;
• Metabolic disorders.

The occurrence of a subacute form of ataxia is most often associated with an intracerebral tumor - astrocytoma, hemangioblastoma, medulloblastoma ependymoma. Moreover, the tumor is located in the cerebellum, compressing and destroying its structures. But not only tumors cause the subacute form of cerebellar ataxia. The reasons listed above can also cause it to occur.

The chronic form of ataxia is often the result of many years of alcoholism and chronic intoxications– substance abuse or drug addiction. Hereditary forms of ataxia are most often associated with genetic diseases:

• Friedreich's ataxia, manifested by disturbances in walking, speech, handwriting, and hearing. The disease is characterized by progressive muscle atrophy involving the optic nerve in the degenerative process, which leads to blindness. Over a long period of time, intelligence decreases and dementia occurs;
• Hereditary cerebellar ataxia of Pierre-Marie, which has a high tendency to progression, consists of cerebellar hypoplasia, that is, its underdevelopment. This is manifested by disturbances in gait, speech and facial expressions, involuntary muscle twitches, decreased strength in the limbs, and twitching of the eyeballs. These symptoms are combined with depression and decreased intelligence. The disease usually makes itself felt around the age of 35;
• Holmes cerebellar atrophy;
• Tardive cerebellar ataxia or cortical cerebellar atrophy Marie-Foy-Alajouanina;
• Olivopontocerebellar degeneration (OPCD).

Cerebellar ataxia and symptoms

The symptoms of ataxia are quite specific. It immediately catches your eye. It is very difficult to miss the occurrence of a disorder. The main characteristic symptoms for cerebellar ataxia are:

• Sweeping, uncertain, uncoordinated movements, as a result of which a person may fall;
• Unsteady gait that prevents you from walking in a straight line. Moreover, patients are so unsteady on their feet that they prefer to spread their legs wide for greater stability and balance with their hands;
• Involuntary stops of motor activity earlier than planned;
• Increased motor amplitude;
• Inability to stand upright;
• Involuntary swaying from side to side;
• Intention tremor, which is characterized by the absence of tremors at rest and intense tremor when moving;
• Nystagmus, which is involuntary twitching eyeballs;
• Adiadochokinesis, which is manifested by the patient’s inability to quickly perform alternating opposite motor acts. Such people cannot quickly perform the “unscrewing a light bulb” movement. Their hands will not move in concert;
• Impaired handwriting, which becomes uneven, sweeping and large;
• Dysarthria is a speech disorder in which speech loses its smoothness, slows down, and increased pauses appear between words. Speech is intermittent, chanted - the emphasis is on each syllable;
• Muscular hypotonia, that is, weakness with decreased deep reflexes.

In this case, the phenomena of ataxia increase significantly with a sudden change in the direction of movement, with a sudden rise, with a rapid start of movement. Depending on the nature of the manifestation, two types of ataxia are distinguished:

• Static, which manifests itself at rest. Patients find it difficult to maintain an upright posture;
• Dynamic, which is characterized by signs of disorder during movement.

Diagnostic tests for ataxia

Diagnosis of cerebellar ataxia is not difficult. For the study, functional tests are carried out, which make it possible to separate static ataxia from dynamic one. Static ataxia is more clearly identified with the following tests:

• Romberg, in which the patient is asked to stand up straight, eyes closed and arms extended. There is instability and staggering. It is difficult for a person to maintain coordination. If you ask him to stand on one leg, it will be impossible without losing his balance;
• Walking along a conventional straight line is impossible. A person will deviate to the right or left, back or forward, but will not be able to walk straight along the line;
• Walking with a side step is impossible. Patients seem to dance while performing this movement, and the torso inevitably lags behind the limbs;
• “Stars”, which consists of sequentially taking 3 steps in a straight line, followed by 3 steps back along the same line. The test is carried out with open eyes, and then with closed ones;
• It is impossible to sit with your arms crossed on your chest when leaving a lying position. Normal cerebellar function ensures synchronous contraction of the trunk muscles, as well as the hamstring muscles. Static ataxia deprives the cerebellum of this ability, as a result of which a person is unable to sit down without helping himself with his hands; he falls back, while at the same time his leg rises. This symptom complex bears the name of the author, Babinsky.

To identify dynamic ataxia, the following tests are used:

• Finger-nasal, which is characterized by missing the mark when trying to hit the nose with a finger;
• Hitting the hammer is also difficult. The doctor asks the patient to hit the moving hammer with his finger;
• Heel-knee, the meaning of which is to suggest that the patient, lying on his back, hit the knee of the opposite leg with his heel and lower the heel with sliding movements to the foot of the other leg. Ataxia does not allow you to hit the knee and lower the heel smoothly evenly;
• “Twisting out the light bulb” is a characteristic hand movement that imitates this action. Patients wave their arms unevenly, wildly and roughly;
• To check the redundancy and disproportion of movements, ask the patient to extend his arms to a horizontal level, palms forward. The doctor's command to change the position of the palms down will not be successful. A clear 180° turn is simply impossible. In this case, one hand may rotate excessively, while the other lags behind;
• Finger Doynikova, which consists in the inability to bend the fingers and rotate the hand from a sitting position, when the hand is relaxed and lies on the knees, palms up;
• Finger-digital, in which the patient is asked to close his eyes and is asked to hit with the ends of the index fingers, which are slightly spaced and moved to the sides. Missing and tremor are observed;

An examination by a neurologist reveals decreased muscle tone, nystagmus, dysarthria and tremor. In addition to the doctor’s assessment, instrumental research methods are used. They are aimed at identifying changes in the cerebellum, in its structure - tumor nature, post-traumatic hematomas, congenital anomalies or degenerative changes in cerebellar tissue, compression and displacement of adjacent anatomical structures. Among these methods great importance have:

• Stabilography;
• Vestibulometry;
• Electronystagmography;
• Computed tomography (CT);
• Magnetic resonance imaging (MRI);
• Magnetic resonance angiography (MRA);
• Dopplerography of cerebral vessels.

Laboratory tests are used to identify infectious lesions brain:

• Blood analysis;
• PCR research;
• Lumbar puncture to examine the cerebrospinal fluid for infection or hemorrhage.

In addition, a DNA study is performed to determine the hereditary nature of ataxia. This diagnostic method allows us to identify the risk of having a baby with this pathology in a family where cases of cerebellar ataxia have been recorded.

Treatment of cerebellar ataxia

Treatment of any disease is aimed, first of all, at eliminating the cause of the disease. If ataxia is not genetic character, fundamental therapy should be directed against causative factor, be it a brain tumor, an infectious disease, a circulatory disorder. Depending on the cause, treatment will vary. However, symptomatic therapy has common features. The main drugs to eliminate signs of the disease include:

• Betahistine group drugs (Betaserc, Vestibo, Westinorm);
• Nootropic and antioxidants (Piracetam, Phenotropil, Picamilon, Phenibut, Cytoflavin, Cerebrolysin, Actovegin, Mexidol);
• Medicines that improve blood circulation (Cavinton, Pentoxifylline, Sermion);
• Vitamin B complexes, as well as their complexes (Milgamma, Neurobeks);
• Drugs that affect muscle tone (Mydocalm, Baclofen, Sirdalud);
• Anticonvulsants (Carbamazepine, Pregabalin).

Thus, in case of infectious-inflammatory genesis of the disease, antibacterial or antiviral therapy is prescribed. For vascular disorders, drugs are prescribed that stabilize blood circulation - angioprotective agents, thrombolytics, antiplatelet agents and vasodilators, as well as anticoagulants. Ataxia, which is caused by intoxication, requires detoxification measures with intensive infusion therapy, diuretics and hemosorbic acid.

For ataxias with a hereditary nature of the lesion, there is no radical treatment. In these cases, metabolic therapy is prescribed:

• IN itamins B12, B6 or B1;
• Meldonium;
• Ginko biloba or piracetam preparations.

Cerebellar ataxia of a tumor nature often requires surgical resolution. Chemotherapy or radiation treatment may be prescribed depending on the type of tumor. Any treatment of ataxia is complemented by physiotherapy and massage. This helps prevent muscle atrophy and contractures. Classes are aimed at improving coordination and gait, as well as maintaining muscle tone.

In addition, a gymnastic complex of physical therapy is prescribed, the purpose of which is to reduce incoordination of movements and strengthen the muscle groups of the limbs. Severe clinical symptoms of the disease not only significantly reduce the patient’s quality of life, cerebellar ataxia is fraught with life-threatening consequences. Its complications include:

• Frequent repeated infectious processes;
• Chronic heart failure;
• Respiratory failure.

The prognosis of cerebellar ataxia syndrome depends entirely on the cause of its occurrence. Timely treatment of acute and subacute forms of ataxia caused by vascular pathology, intoxication, inflammation, leads to complete or partial restoration of cerebellar functions. Often, it is not possible to completely cure ataxia. It has a poor prognosis due to the fact that the disease tends to progress.

The disease reduces the patient’s quality of life and causes multiple disorders of other organs and systems. The first warning symptoms require a visit to a doctor. A timely diagnosis and initiation of treatment provide a much higher chance of restoring damaged functions or slowing down the process with a more favorable outcome than in the case of late treatment.

Most severe course has hereditary ataxia. They are characterized by chronic progression with an increase and aggravation of symptoms, which ends in the inevitable disability of the patient. There is no specific prophylaxis against ataxia. The development of the disease can be prevented by preventing injuries, vascular imbalances, intoxications, and infections. And when they appear - timely treatment.

Hereditary pathology can be avoided only through genetic consultation with a specialist about planning the birth of a child. To do this, collect the maximum amount of information about hereditary diseases in the family. They analyze possible risks and may take samples for DNA testing. All this allows us to preliminary assess the possibility of giving birth to a child with a genetic disease. Planning pregnancy is a prevention for many diseases.

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