Tag Archives: Spinal cord

Lhermitte’s phenomenon

Alternative Name: Barber Chair phenomenon

Definition:

Lhermitte’s phenomenon  is an electrical sensation that runs down the back and into the limbs. In many patients, it is elicited by bending the head forward. It can also be evoked when a practitioner pounds on the posterior cervical spine while the neck is flexed; caused by involvement of the posterior columns

CLICK & SEE THE PICTURES

The Lhermitte’s sign is a symptom rather than a sign as it describes a subjective sensation rather than an objective finding. To add more confusion, it is not attributed to its discoverer. It was first described by Pierre Marie and Chatelin in 1917. Jean Lhermitte did not publish his first report until 1920. However, in 1924 he did publish the seminal article on the subject which resulted in it becoming well known

It’s usually triggered by flexing the neck – that is, bending your head down, chin towards chest. The sensation is short-lived, usually no more than a second.

How often the symptom occurs, and what other symptoms develop along with it, depends on the underlying cause, of which there are several.

Causes:
L’hermitte’s phenomenon is a sign that something may be damaging the spinal cord (especially in the part of it that’s composed of white matter, at the back of the cord). This damage is usually in the neck or region of the spine known as the cervical spine. But the symptom is very non-specific and says nothing about exactly where in the spinal cord the problem is, or what is damaging it.

The most common cause is arthritis of the small joints of the vertebra in that part of the spine, also known as cervical spondylosis. This can cause abnormal pressure on the spinal cord or the nerves coming out of it.

Other causes include:

•Multiple sclerosis
•Vitamin B12 deficiency (pernicious anaemia)
•Tumours
•Compression of the discs in the cervical spine following trauma
•Radiotherapy to the neck

But in many cases a specific cause for Lhermitte’s phenomenon can’t be found.

Treatment:
It’s important that L’hermitte’s phenomenon is investigated by a specialist to pick up and treat any identifiable cause if possible, and limit or prevent further damage. But in many cases the tests (which may include X-ray of the cervical spine, MRI scans of the brain and cervical spinal cord, lumbar puncture and nerve signal tests known as visual evoked potentials) all come back negative.

When this happens, you should keep an eye on the problem and ask your doctor to repeat the tests if necessary or if symptoms worsen.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://en.wikipedia.org/wiki/Lhermitte’s_sign
http://www.bbc.co.uk/health/physical_health/conditions/lhermittes.shtml

http://www.msrc.co.uk/index.cfm/fuseaction/show/pageid/755

http://commons.wikimedia.org/wiki/File:Illu_vertebral_column.jpg

Kyphosis

Alternative Names: Scheuermann’s disease; Roundback; Hunchback; Postural kyphosis

Definition:
Kyphosis is a curving of the spine that causes a bowing or rounding of the back, which leads to a hunchback or slouching posture.

click to see the picture

Some rounding is normal, but the term “kyphosis” usually refers to an exaggerated rounding, more than 50 degrees. This deformity is also called round back or hunchback.

click to see the picture

With kyphosis, your spine may look normal, or you may develop a hump. Kyphosis can occur as a result of developmental problems; degenerative diseases, such as arthritis of the spine; osteoporosis with compression fractures of the vertebrae; or trauma to the spine. It can affect all ages.

In the sense of a deformity, it is the pathological curving of the spine, where parts of the spinal column lose some or all of their lordotic profile. This causes a bowing of the back, seen as a slouching back and breathing difficulties. Severe cases can cause great discomfort and even lead to death.

Causes:

Our spine (vertebral column) is composed of bones (vertebrae), which are held together by tough, fibrous bands (ligaments). The vertebral column consists of seven neck (cervical) vertebrae, 12 middle back (thoracic) vertebrae and five lower back (lumbar) vertebrae. Lumbar vertebrae are the largest, and they carry most of your body’s weight. The sacrum, containing five fused vertebrae, is below the lumbar vertebrae. The last three tiny vertebrae, also fused together, are called the tailbone (coccyx).

Kyphosis is a forward rounding of the vertebrae in your thoracic spine. The vertebrae in your thoracic spine connect to your ribs.

Causes of kyphosis depend on the different types of kyphosis.
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Types of kyphosis in children and adolescents
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For children or adolescents, the most common types include:

*Postural kyphosis. This type mainly becomes apparent in adolescence. The onset of postural kyphosis generally is slow. It’s more common in girls. Poor posture or slouching may cause stretching of the spinal ligaments and abnormal formation of the bones of the spine (vertebrae). Postural kyphosis often is accompanied by an exaggerated inward curve (hyperlordosis) in the lower (lumbar) spine. Hyperlordosis is the body’s way of compensating for the exaggerated outward curve in the upper spine.

*Scheuermann’s kyphosis.
Like postural kyphosis, Scheuermann’s kyphosis typically appears in adolescence, often between ages 10 and 15, while the bones are still growing. Also called Scheuermann disease, it’s slightly more common in boys. Scheuermann’s kyphosis may deform the vertebrae so that they appear wedge shaped, rather than rectangular, on X-rays. There may be another finding, known as Schmorl’s nodes, on the affected vertebrae. These nodes are the result of the cushion (disk) between the vertebrae pushing through bone at the bottom and top of a vertebra (end plates).

The cause of Scheuermann’s kyphosis is unknown, but it tends to run in families. Some people with this type of kyphosis also have scoliosis, a spinal deformity that causes a side-to-side curve. Adults who developed Scheuermann’s during childhood may experience increased pain as they get older.

*Congenital kyphosis
. A malformation of the spinal column during fetal development causes kyphosis in some infants. Several vertebrae may be fused together or the bones may not form properly. This type of kyphosis may worsen as the child grows. In some cases, congenital kyphosis eventually leads to paralysis of the lower body (paraplegia).

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Causes in adults
:
Disorders that may cause a curvature of the spine in adults, resulting in kyphosis, include:

*Osteoporosis,
a bone-thinning disease that’s associated with fractures of the vertebrae, which cause compression of the spine and contribute to kyphosis
*Degenerative arthritis of the spine, which can cause deterioration of the bones and disks of the spine
*Ankylosing spondylitis, an inflammatory arthritis that affects the spine and nearby joints
*Connective tissue disorders, such as Marfan syndrome, that may affect the connective tissue’s ability to hold joints in their proper position
*Tuberculosis and other infections of the spine, which can result in destruction of joints
*Cancer or benign tumors that impinge on bones of the spine and force them out of position
*Spina bifida, a birth defect in which part of the spine doesn’t form completely, and which causes defects of the spinal cord and vertebrae
*Conditions that cause paralysis, such as cerebral palsy and polio, and that stiffen the bones of the spine

Symptoms:
•Difficulty breathing (in severe cases)
•Fatigue
•Mild back pain
•Round back appearance
•Tenderness and stiffness in the spine


Diagnosis:

TestsPhysical examination by Your doctor confirms the abnormal curve of the spine. Your doctor will record a history of your condition and conduct a physical exam. The  physical  exam  may include the following:

*Forward bend tes
t. Your doctor asks you to bend forward from the waist while he or she views the spine from the side. With kyphosis, the rounding of the upper back may become more obvious in this position. In postural kyphosis, the deformity corrects itself when you lie on your back.
*Neurological functions test. Although neurological changes accompanying kyphosis are rare, your doctor may check for them by looking for weakness, changes in sensation or paralysis below the site of the kyphosis.
*Spinal imaging tests. Your doctor may take an X-ray to confirm the kyphosis, determine the degree of curvature and detect any deformity of the vertebrae, which helps identify the type of kyphosis. For example, the appearance of wedge-shaped vertebrae or other features on X-ray differentiates between postural kyphosis and Scheuermann’s kyphosis. In older adults, X-rays may show arthritic changes in the spine, which can contribute to an increase in pain. If your doctor suspects a tumor or infection, he or she may request an MRI of your spine.
*Pulmonary function tests. Your doctor may also use breathing tests to assess any breathing difficulty caused by the kyphosis.

The doctor will also look for any nervous system (neurological) changes (weakness, paralysis, or changes in sensation) below the curve.


Other tests may include:

•Spine x-ray
•Pulmonary function tests (if kyphosis affects breathing)
•MRI (if there may be a tumor, infection, or neurological symptoms)

Treatment:

Kyphosis treatment depends on the cause of the condition and the signs and symptoms that are present.

Less serious cases

In some cases, less aggressive types of treatment are appropriate:

*Postural kyphosis. This type of kyphosis doesn’t progress and may improve on its own. Exercises to strengthen back muscles, training in using correct posture and sleeping on a firm bed may help. Pain relievers may help ease discomfort if exercise and physical therapies aren’t fully effective.
*Structural kyphosis. For kyphosis caused by spinal abnormalities, treatment typically depends on your age and sex, the severity of your symptoms and how rigid the curve in your spine is. With Scheuermann’s kyphosis, monitoring for progression of the curvature may be all that’s recommended if you have no symptoms. Anti-inflammatory medications may help relieve pain. General conditioning exercises and physical therapy may help alleviate symptoms.
*Osteoporosis-related kyphosis. Multiple compression fractures in people who have low bone density can lead to abnormal curvature of the spine. If no pain or other complications are present, treatment for the kyphosis may not be necessary. But your doctor may recommend treatment of the osteoporosis to prevent further fractures and worsening of the kyphosis.
More serious cases
More severe cases of kyphosis require more aggressive treatment. The primary approaches are bracing and, as a last resort, surgery. With children and adolescents, the sooner treatment begins, the more effective it may be in halting the deformity.

When bracing is necessary

If your teenager is still growing and has moderate to severe kyphosis, your doctor may recommend bracing. Wearing a brace may slow or prevent further progression of the curvature and may even provide some correction.

There are several types of braces for children who have kyphosis. Your doctor can help you decide which brace would be most effective for your child.

Children who wear braces usually have few restrictions and can participate in most activities. Although a brace may feel uncomfortable and awkward at first, it must be worn as prescribed to be effective. Once the bones are fully grown, your child can be weaned off the brace according to your doctor’s instructions.

There are different types of braces for treating kyphosis in adults, varying from postural training devices to rigid body jackets. The goal of bracing in adults is typically to control pain.

When surgery is necessary

Spinal surgery carries many risks, so your doctor may recommend surgery only if you or your child has any of the following:

*Severe curvature of the spine that doesn’t respond to other treatment measures
*Kyphosis that continues to worsen
*Debilitating pain that doesn’t respond to medication
*Resulting neurological problems, such as paralysis
*Kyphosis related to a tumor or infection
Surgery also may be recommended for an infant with congenital kyphosis, in order to straighten the spine.

The goal of surgery is to reduce the degree of curvature. This is commonly done by fusing or joining the affected vertebrae. Doctors typically perform the surgery through incisions in the back, during general anesthetic.

Fusing the vertebrae involves connecting two or more of them with pieces of bone taken from the pelvis. Eventually, the vertebrae fuse with the bone pieces to prevent further progression of the curvature. Doctors attach metal rods, hooks, screws or wires to the spine to hold the vertebrae together while the bones fuse, which may take several months. Doctors leave the metal in the body to help support the fused area even after the bones have fused.

A drawback of spinal fusion is that it stops growth in that area of the spine. A child’s ultimate height isn’t affected greatly because the leg bones and the unaffected portion of the spine continue to grow normally.

The complication rate for spinal surgery is relatively high. Complications include bleeding, infection, pain, nerve damage, arthritis and disk degeneration. If the surgery fails to correct the problem, a second surgery may be needed.

Other procedures
Procedures called vertebroplasty and kyphoplasty have been developed recently to treat vertebral fractures. These procedures involve injecting a type of inert cement into the affected vertebrae. They can be effective in controlling pain associated with compression .

Coping & Support:
Adolescence is a time when young people are struggling with physical and emotional changes. Having a noticeable spinal deformity or wearing a brace can make this challenging time even more difficult.

Make sure your child has caring people to turn to, including supportive family and friends, or even a professional counselor, if necessary. Consider joining a support group for parents and kids with kyphosis or other spinal deformities to help you and your child connect with others facing similar challenges.

Prognosis:
Adolescents with Scheuermann’s disease tend to do well even if they need surgery, and the disease stops once they stop growing. If the kyphosis is due to degenerative joint disease or multiple compression fractures, surgery is needed to correct the defect and improve pain.


Possible Complications

•Decreased lung capacity
•Disabling back pain
•Neurological symptoms including leg weakness or paralysis
•Round back deformity

Prevention:

Treating and preventing osteoporosis can prevent many cases of kyphosis in the elderly. Early diagnosis and bracing of Scheuermann’s disease can reduce the need for surgery, but there is no way to prevent the disease.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Kyphosis
http://www.mayoclinic.com/health/kyphosis/DS00681
http://www.nlm.nih.gov/medlineplus/ency/imagepages/9561.htm
http://www.spineuniverse.com/conditions/kyphosis/kyphosis-scheuermanns-disease
http://www.nlm.nih.gov/medlineplus/ency/article/001240.htm
http://www.bbc.co.uk/health/physical_health/conditions/backcurves1.shtml

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Tool ‘May Help’ Early Meningitis Diagnosis

The most dangerous form of  meningitis can kill within hours – but doctors think they have developed the best way to identify it early.

The “predictive model” developed by the Health Protection Agency could clear the way for the right treatment to be given quickly.

It uses a combination of blood tests and symptoms to help identify bacterial meningitis.

A simple way to test the rash is to press a clear glass against the skin

Charities welcomed the model, while calling for further testing.

Meningitis is an inflammation in the membranes surrounding the spinal cord and brain. It is most often caused by either bacterial or viral infection.

Knowing which is which can make a big difference to the best treatment.

Bacterial meningitis needs antibiotic treatment as soon as possible – and it is often prudent to give these drugs to close family members as well.

Rash

There are tests to identify the cause of meningitis, the best known being a lumbar puncture to obtain spinal fluid for analysis.

However, this does not always yield clear-cut results.

The new model has a simple set of three criteria which helps doctors tell the difference without having to wait for conclusive spinal fluid results.

Researchers found them by examining 385 confirmed meningitis cases over a 12-month period.

The first two criteria are blood tests positive for two specific chemicals associated with bacterial meningitis, the third is the presence of the “classic” meningitis rash of spots which do not disappear when pressed with a glass.

The three results are combined to provide a score which then tells the doctor how likely bacterial meningitis is.

Dr Toyin Ejidokun, a consultant in communicable disease at the HPA, said: “The total score allows a treating clinician to simply and quickly assess the likelihood of whether or not the case is bacterial meningitis by checking it against the predictive probabilities we have developed.

“While further testing needs to take place to test the accuracy of the model, it offers the prospect of a rapid predictive tool to help clinical and public health management of suspected bacterial meningitis cases.”

‘Step forward’

Steve Dayman, the chief executive of Meningitis UK, said the protocol was “an excellent step forward”.

He said: “It’s vital that the differentiation between bacterial and viral meningitis is made straight-away because the bacterial form can kill in less then four hours. Quick treatment can mean the difference between life and death.

“In the absence of a vaccine to protect against all forms of meningitis, this new model could help to save precious lives.”

Experts said people should still be vigilant for the warning signs of meningitis to maximise the chances of recovery.

Although not every patient has every symptom, common signs include a combination of “classic rash”, suddenly appearing high fever, a severe and worsening headache, stiff neck, vomiting, joint and muscle pain, a dislike of bright lights, very cold hands and feet, and severe drowsiness.

A spokesman for the Meningitis Research Foundation said: “Early detection of meningitis and septicaemia is critical when treating these diseases, every second matters.

“We welcome all research and development to identify meningitis early so treatment of antibiotics can be administered as soon as possible to prevent the worst outcome.”

However, she said that doctors should stick with existing protocols for diagnosing and treating meningitis until the new version had been fully tested.

Source : BBC News:

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New Discovery On Cause Of Tremor

 

In a new discovery, UK scientists have found a mechanism in the spine that counteracts the brain waves that produce tremor: they suggest the discovery could help around 1 million people in the UK who suffer from shakes and tremors.

A paper on the research that led to the discovery, which was funded by the Wellcome Trust, and conducted by scientists at the Institute of Neuroscience at Newcastle University, Newcastle upon Tyne, was published online ahead of print in the 1 June issue of the Proceedings of the National Academy of Sciences.

Most healthy individuals have experienced mild tremor, it is not uncommon when we feel tired, hungry or nervous, but more severe forms can be a symptom of neurological disease, including Parkinson’s, Multiple Sclerosis and also Essential Tremor which is usually a disease of old age but it can also affect young people and it often leaves patients unable to walk unaided.

Dr Stuart Baker, professor of movement neuroscience at Newcastle, told the media that:

“We don’t fully understand the brain systems causing these tremors but they can really have a massive impact on someone’s quality of life. They lose their independence and can’t do something as simple as make a cup of tea.”

Baker explained the approach they took in their research: instead of looking at why people have tremors, they decided to investigate why most people don’t have them.

He said that the part of the brain that controls movement produces brain waves the work at 10 cycles per second, so in theory everyone should have tremors that have that frequency.

In fact we do, said Baker, but the tremor is so smal that we don’t notice it. So he and his team wondered if there was another process at work, one that countered the effect of the 10 cycles per second.

For their study, Baker and colleagues used macaque monkeys: they taught them how to move their index finger backwards and forwards very slowly, which exacerbated the natural minor tremor that we humans and our primate relatives have in common.

They then recorded nerve cell activity in the brain and spinal cord as the animals performed their slow finger movements.

The results showed that not only was the rhythm of nerve cell activity in the brain and spinal cord oscillating at around the same frequency as the tremor, but that the spinal cord was exactly out of phase with the brain, effectively cancelling out its oscillations and thus reducing the size of the tremor.

The researchers wrote that:

Convergence of antiphase oscillations from the SC [spinal cord] with cortical and subcortical descending inputs will lead to cancellation of approximately 10 Hz oscillations at the motoneuronal level.”

They concluded that:

“This could appreciably limit drive to muscle at this frequency, thereby reducing tremor and improving movement precision. ”

Baker said there are many types of disease associated with tremor, and perhaps in some of these the controller in the spine malfunctions and that is what actually leads to tremor.

In other diseases, he said, we already know the cause of tremor is a problem in brain regions that produce abnormally high oscillations.

“But even then, the spinal system we have discovered will reduce tremors, making the symptoms much less severe than they would otherwise be,” he added.

The researchers suggested that the more we understand about how the spinal controller works, the better chance we have of developing treatments that adjust it to work better and thereby reduce the levels of tremor that patients experience and improve their quality of life.

“Spinal interneuron circuits reduce approximately 10-Hz movement discontinuities by phase cancellation.”

Source: Medical News Today.Jun 2. 2010

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Ataxia

Definition:
Ataxia (from Greek , meaning “lack of order”) is a neurological sign and symptom consisting of gross lack of coordination of muscle movements. Ataxia is a non-specific clinical manifestation implying dysfunction of parts of the nervous system that coordinate movement, such as the cerebellum. Several possible causes exist for these patterns of neurological dysfunction. The term “dystaxia” is rarely used as a synonym.

A sign of an underlying condition, ataxia can affect your movements, your speech, your eye movements and your ability to swallow.
………………….click & see
Persistent ataxia usually results from damage to your cerebellum — the part of your brain that controls muscle coordination. Many conditions may cause ataxia, including alcohol abuse, stroke, tumor, cerebral palsy and multiple sclerosis. It’s also possible to inherit a defective gene that may cause one of many ataxia variants.

Types of ataxia:-

#Cerebellar ataxia:
The term cerebellar ataxia is employed to indicate ataxia due to dysfunction of the cerebellum. This causes a variety of elementary neurological deficits, such as antagonist hypotonia, asynergy, dysmetria, dyschronometria, and dysdiadochokinesia. How and where these abnormalities manifest depend on which cerebellar structures are lesioned, and whether the lesion is bilateral or unilateral.

*Dysfunction of the vestibulocerebellum impairs balance and control of eye movements. This presents with postural instability, in which the person tends to separate the feet on standing to gain a wider base and avoid oscillations (especially posterior-anterior ones); instability is therefore worsened when standing with the feet together (irrespective of whether the eyes are open or closed: this is a negative Romberg’s test, or more accurately, denotes the inability to carry out the test as the individual is unstable even with open eyes).

*Dysfunction of the spinocerebellum presents with a wide-based “drunken sailor” gait, characterised by uncertain start and stop, lateral deviations, and unequal steps. This part of the cerebellum regulates body and limb movements.

*Dysfunction of the cerebrocerebellum presents with disturbances in carrying out voluntary, planned movements, including intention tremor (coarse trembling, accentuated over the execution of voluntary movements, possibly involving the head and eyes as well as the limbs and torso), peculiar writing abnormalities (large, unequal letters, irregular underlining), and a peculiar pattern of dysarthria (slurred speech, sometimes characterised by explosive variations in voice intensity despite a regular rhythm).

#Sensory ataxia:
The term sensory ataxia is employed to indicate ataxia due to loss of proprioception (sensitivity to joint and body part position), which generally depends on dysfunction of the dorsal columns of the spinal cord, since they carry proprioceptive information up to the brain; in some cases, the cause may instead be dysfunction of the various brain parts that receive that information, including the cerebellum, thalamus, and parietal lobes. Sensory ataxia presents with an unsteady “stomping” gait with heavy heel strikes, as well as postural instability that is characteristically worsened when the lack of proprioceptive input cannot be compensated by visual input, such as in poorly lit environments. Doctors can evidence this during physical examination by having the patient stand with his / her feet together and eyes shut, which will cause the patient’s instability to markedly worsen, producing wide oscillations and possibly a fall (this is called a positive Romberg’s test). Worsening of the finger-pointing test with the eyes closed is another feature of sensory ataxia. Also, when the patient is standing with arms and hands extended toward the examiner, if the eyes are closed, the patient’s finger will tend to “fall down” and be restored to the horizontal extended position by sudden extensor contractions (“ataxic hand”).

#Vestibular ataxia:
The term vestibular ataxia is employed to indicate ataxia due to dysfunction of the vestibular system, which in acute and unilateral cases is associated with prominent vertigo, nausea and vomiting. In slow-onset, chronic bilateral cases of vestibular dysfunction, these characteristic manifestations may be absent, and dysequilibrium may be the sole presentation.

Symptoms:-
Symptoms may vary depending on the severity and type of ataxia, of which there are many. If the ataxia is caused by an injury or another health condition, symptoms may emerge at any age, and may well improve and eventually disappear.

Initial ataxia symptoms usually include:
*Poor limb coordination.
*Dysarthria – slurred and slow speech that is difficult to produce. The patient may also have difficulties controlling volume, rhythm, and pitch.

If the ataxia advances other symptoms may also appear:

*Swallowing difficulties, which may sometimes result in choking or coughing.
*Facial expressions become less apparent.
*Tremors – parts of the body may shake or tremble unintentionally.
*Nystagmus – involuntary rapid rhythmic repetitious eye movement. Movements may be vertical, horizontal, or circular.
*Pes cavus – a foot with too high an arch.
*Cold feet – because of a lack of muscle activity.
*Problems with balance.
*Walking difficulties – in severe cases the patient may need a wheelchair.
*Vision problems.
*Hearing problems.
*Depression – as a result of having to live and cope with the symptoms.

Cerebellar ataxias:
Cerebellar ataxia early onset usually emerges between the ages of 4 and 26. Late onset ataxia generally appears after the patient is 20 years old. Late-onset ataxias usually present less severe symptoms, compared to early-onset ataxia.

Ataxia telangiectasia symptoms generally include:
*Small veins appear around the corner of the eyes, cheeks and ears.
*Physical and sexual development is usually delayed.

Friedreich’s ataxia symptoms generally include:
*The spine curves sideways (scoliosis).
*The heart muscle becomes weaker (cardiomyopathy).
*Diabetes.

For patients whose symptoms are caused by injury or illness, symptoms often improve over time, and eventually go away completely.

When to see a doctor:-
If you aren’t aware of having a condition that causes ataxia, such as multiple sclerosis, see your doctor if you:

*Lose balance
*Lose muscle coordination in a hand, arm or leg
*Have difficulty walking
*Slur your speech
*Have difficulty swallowing

Causes:-
The three types of ataxia have overlapping causes, and can therefore either coexist or occur in isolation.

Focal lesions
Any type of focal lesion of the central nervous system (such as stroke, brain tumour, multiple sclerosis) will cause the type of ataxia corresponding to the site of the lesion: cerebellar if in the cerebellum, sensory if in the dorsal spinal cord (and rarely in the thalamus or parietal lobe), vestibular if in the vestibular system (including the vestibular areas of the cerebral cortex).

Exogenous substances
Exogenous substances that cause ataxia mainly do so because they have a depressant effect on central nervous system function. The most common example is ethanol, which is capable of causing reversible cerebellar and vestibular ataxia. Other examples include various prescription drugs (e.g. most antiepileptic drugs have cerebellar ataxia as a possible adverse effect), marijuana ingestion[2] and various other recreational drugs (e.g. ketamine, PCP or dextromethorphan, all of which are NMDA receptor antagonists that produce a dissociative state at high doses).

Vitamin B12 deficiency
Vitamin B12 deficiency may cause, among several neurological abnormalities, overlapping cerebellar and sensory ataxia.

Causes of isolated sensory ataxia

Peripheral neuropathies may cause generalised or localised sensory ataxia (e.g. a limb only) depending on the extent of the neuropathic involvement. Spinal disorders of various types may cause sensory ataxia from the lesioned level below, when they involve the dorsal columns.

Non-hereditary cerebellar degeneration
Non-hereditary causes of cerebellar degeneration include chronic ethanol abuse, paraneoplastic cerebellar degeneration, high altitude cerebral oedema, coeliac disease, normal pressure hydrocephalus and cerebellitis.

Hereditary ataxias
Ataxia may depend on hereditary disorders consisting of degeneration of the cerebellum and/or of the spine; most cases feature both to some extent, and therefore present with overlapping cerebellar and sensory ataxia, even though one is often more evident than the other. Hereditary disorders causing ataxia include autosomal dominant ones such as spinocerebellar ataxia, episodic ataxia, and dentatorubropallidoluysian atrophy, as well as autosomal recessive disorders such as Friedreich’s ataxia (sensory and cerebellar, with the former predominating) and Niemann Pick disease, ataxia-telangiectasia (sensory and cerebellar, with the latter predominating), and abetalipoproteinaemia. An example of X-linked ataxic condition is the rare fragile X-associated tremor/ataxia syndrome.

GeneReview/NIH/UW entry on Hereditary Ataxia Overview

Arnold-Chiari Malformation
Arnold-Chiari malformation is a malformation of the brain. It consists of a downward displacement of the cerebellar tonsils and the medulla through the foramen magnum, sometimes causing hydrocephalus as a result of obstruction of CSF (cerebrospinal fluid) outflow.

Diagnosis:-
Besides conducting a physical exam and a neurological exam, including checking your memory and concentration, vision, hearing, balance, coordination and reflexes, your doctor may request these laboratory tests:

#Blood tests. Certain blood tests can confirm or exclude the suspected condition. A sample of your blood will be drawn from your arm through a needle. You may be required to fast from midnight the night before your appointment until after your blood is drawn. The specific tests will depend on the suspected cause, but most likely will include a complete blood count (CBC), which helps evaluate your overall health and detect a range of disorders, including infection and heavy metal poisoning.

#Urine tests. Examining a sample of your urine under a microscope (urinalysis) may suggest certain systemic abnormalities that can be related to some forms of ataxia. If your doctor suspects Wilson’s disease, you may be asked for a 24-hour urine collection to help determine the amount of copper in your system.

#Imaging studies. A computerized tomography (CT) scan or magnetic resonance imaging (MRI) of your brain may help determine potential causes.

#Genetic testing. Your doctor may recommend genetic testing to determine whether you or your child has the gene mutation that causes one of the hereditary ataxic conditions. Gene tests are available for many but not all of the hereditary ataxias.

Treatments:-
There’s no treatment specifically for ataxia and it is not curable  but a great deal can be done to ease symptoms and improve the quality of life of the patient. Treatment for coordination and balance problems usually involves the use of adaptive devices which help the patient attain as much independence as possible. These may include the use of a cane (walking stick), crutches, walker or a wheelchair. Symptoms such as tremor, stiffness, spasticity, sleep disorders, muscle weakness, depression (or frustration, sadness and anger) may be addressed with targeted physical therapy, speech therapy, medications and counseling.

Occupational therapy – the occupational therapist can help the patient manage better around the house and work. This may involve some home adaptations, wheelchair assessments, and making the kitchen more practical for the patient.

#Speech therapy – the speech therapist can help with swallowing, coughing, choking and speech problems. If speech becomes very difficult the speech therapist can help the patient learn how to use speech aids.

#Orthopedic care – this can help patients with curvature of the spine (scoliosis).

Physical therapy (physiotherapy) – a physical therapist (physiotherapist) can help maintain strength and improve mobility.

#Physical therapy to help you build strength and enhance your mobility
#Occupational therapy to help you with daily living tasks, such as feeding yourself
#Speech therapy to improve speech and aid swallowing

*Counseling – patients with ataxia commonly become frustrated and depressed; this usually results from having to cope with some symptoms which affect physical mobility and coordination. Talking to a well qualified counselor, such as a psychotherapist can help.

*Supplements and nutrition – some patients with ataxia have very low levels of vitamin E and require supplements and/or a special diet. As sensitivity to gluten is more common among ataxia patients, a gluten-free diet also helps.

*Medication – some patients with ataxia telangiectasia are prescribed gamma-globulin injections to boost their immune systems. There are also drugs for muscle spasms and uncontrollable eye movements.

Coping and support:-
The challenges you face when living with ataxia, such as loss of independence, or having a child with the condition, may make you feel alone or lead to depression and anxiety. Talking to a counselor or therapist may lessen your sense of isolation and help you cope. Or you may find encouragement and understanding in a support group, either for ataxia or for your underlying condition, such as cancer or multiple sclerosis.

Although support groups aren’t for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences. If you’re interested, your doctor may be able to recommend a group in your area.

Other uses of the term:-
The term “ataxia” is sometimes used in a broader sense to indicate lack of coordination in some physiological process. Examples include optic ataxia (lack of coordination between visual inputs and hand movements, resulting in inability to reach and grab objects, usually part of Balint’s syndrome, but can be seen in isolation with injuries to the superior parietal lobule, as it represents a disconnection between visual-association cortex and the frontal premotor and motor cortex), and ataxic respiration (lack of coordination in respiratory movements, usually due to dysfunction of the respiratory centres in the medulla oblongata).

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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.mayoclinic.com/health/ataxia/DS00910
http://en.wikipedia.org/wiki/Ataxia
http://www.medicalnewstoday.com/articles/162368.php

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