Skip to main content Accessibility help
×
Home
  • Print publication year: 2012
  • Online publication date: August 2012

Chapter 3 - Cerebellar ataxia

from Section 1 - Clinical manifestations

Summary

Ataxia is the most important sign of cerebellar disease, but there are other potential causes of ataxia. Postural and limb tremor are additional signs of cerebellar disease. Patients with cerebellar disorders may walk with a wide-based, staggering gait, making it seem as if they were intoxicated by alcohol. Frontal lobe disorders might cause cerebellar-like symptoms with walking difficulties and clumsiness. Frontal lobe lesions are commonly associated with impairment of cognitive function and changes in personality, and often cause urinary incontinence. Lesions of the cerebellar hemisphere are followed by ipsilateral limb ataxia including hypotonia in acute lesions, and if the dentate nucleus is involved, kinetic tremor. Vascular lesions of the cerebellum itself and of the corticopontocerebellar and dentatothalamic pathways might result in ataxia. Limb ataxia and ataxia of gait are common in superior cerebellar artery (SCA), the posterior inferior cerebellar artery (PICA), and the anterior inferior cerebellar artery (AICA) territory infarctions.

Related content

Powered by UNSILO

References

1. CampbellWW.DeJong's The Neurological Examination. 6th edn. Philadelphia, PA: Lippincott Williams and Wilkins, 2005.
2. TimmannD, DienerHC.Coordination and ataxia. In: GoetzCG, ed. Textbook of Clinical Neurology. 3rd edn. Philadelphia, PA: Saunders (Elsevier), 2007; 307–325.
3. HolmesG.The cerebellum of man. Brain 1939; 62: 1–30.
4. LeinerHC, LeinerAL, DowRS.Reappraising the cerebellum: what does the hindbrain contribute to the forebrain?Behav Neurosci 1989; 103: 998–1008.
5. SchmahmannJD, ShermanJC.The cerebellar cognitive affective syndrome. Brain 1998; 121: 561–579.
6. StrickPL, DumRP, FiezJA.Cerebellum and nonmotor function. Annu Rev Neurosci 2009; 32: 413–434.
7. TimmannD, DaumI.How consistent are cognitive impairments in patients with cerebellar disorders?Behav Neurol 2010; 23: 81–100.
8. BrodalP.The Central Nervous System. Structure and Function. 3rd edn. Oxford: Oxford University Press, 2004.
9. SchmahmannJD, DoyonJ, TogaAW, PetridesM, EvansAC.MRI Atlas of the Human Cerebellum. San Diego, CA: Academic Press, 2000.
10. JansenJ, BrodalA.Experimental studies on the intrinsic fibres of the cerebellum. II. The corticonuclear projection. J Comp Neurol 1940; 73: 267–321.
11. BloedelJR, CourvilleJ.Cerebellar afferent systems. In: Handbook of Physiology. Bethesda, MD: American Physiological Society, 1982; 735–830.
12. GlicksteinM, DoronK.Cerebellum: connections and functions. Cerebellum 2008; 7: 589–594.
13. BrodalA.Neurological Anatomy in Relation to Clinical Medicine. 3rd edn. New York, NY: Oxford University Press, 1981.
14. DumRP, StrickPL.An unfolded map of the cerebellar dentate nucleus and its projections to the cerebral cortex. J Neurophysiol 2003; 89: 634–639.
15. NaidichTP, DuvernoyHM, DelmanBN, et al. Duvernoy's Atlas of the Human Brain Stem and Cerebellum. Wien: Springer-Verlag, 2009.
16. TatuL, MoulinT, BogousslavskyJ, DuvernoyH.Arterial territories of human brain: brainstem and cerebellum. Neurology 1996; 47:1125–1135.
17. AmarencoP.The spectrum of cerebellar infarctions. Neurology 1991; 41: 973–979.
18. MarinkovicS, KovacevicM, GiboH, MilisavljevicM, BumbasirevicL.The anatomical basis for the cerebellar infarcts. Surg Neurol 1995; 44: 450–460.
19. DichgansJ, DienerHC.Clinical evidence of functional compartmentalization of the cerebellum. In: BloedelJR, DichgansJ, PrechtW, eds. Cerebellar Functions. Berlin, Germany: Springer-Verlag, 1985; 126–147.
20. ManniE, PetrosiniL.A century of cerebellar somatotopy: a debated representation. Nat Rev Neurosci 2004; 5: 241–249.
21. UrbanPP, MarxJ, HunscheS, et al. Cerebellar speech representation: lesion topography in dysarthria as derived from cerebellar ischemia and functional magnetic resonance imaging. Arch Neurol 2003; 60: 965–972.
22. SchochB, DimitrovaA, GizewskiER, TimmannD. Functional localization in the human cerebellum based on voxelwise statistical analysis: a study of 90 patients. Neuroimage 2006; 30: 36–51.
23. KaseCS, NorrvingB, LevineSR, et al. Cerebellar infarction. Clinical and anatomic observations in 66 cases. Stroke 1993; 24: 76–83.
24. ChavesCJ, CaplanLR, ChungCS, et al. Cerebellar infarcts in the New England Medical Center Posterior Circulation Stroke Registry. Neurology 1994; 44: 1385–1390.
25. KonczakJ, PierscianekD, HirsigerS, et al. Recovery of upper limb function after cerebellar stroke: lesion symptom mapping and arm kinematics. Stroke 2010; 41: 2191–2200.
26. CaplanLR.Cerebellar infarcts. In: CaplanLR, ed. Posterior Circulation Disease: Clinical findings, Diagnosis, and Management. Cambridge, MA: Blackwell Scientific, 1996; 492–543.
27. AmarencoP, HauwJJ.Cerebellar infarction in the territory of the superior cerebellar artery: a clinicopathologic study of 33 cases. Neurology 1990; 40: 1383–1390.
28. AmarencoP, RosengartA, DeWittLD, PessinMS, CaplanLR.Anterior inferior cerebellar artery territory infarcts. Mechanisms and clinical features. Arch Neurol 1993; 50: 154–161.
29. BarthA, BogousslavskyJ, RegliF.The clinical and topographic spectrum of cerebellar infarcts: a clinical-magnetic resonance imaging correlation study. Ann Neurol 1993; 33: 451–456.
30. TohgiH, TakahashiS, ChibaK, HirataY.Cerebellar infarction. Clinical and neuroimaging analysis in 293 patients. The Tohoku Cerebellar Infarction Study Group. Stroke 1993; 24: 1697–1701.
31. ErdemogluAK, DumanT.Superior cerebellar artery territory stroke. Acta Neurol Scan 1998; 98: 283–287.
32. UrbanPP, WichtS, VukurevicG, et al. Dysarthria in acute ischemic stroke: lesion topography, clinicoradiologic correlation, and etiology. Neurology 2001; 56: 1021–1027.
33. MantoM-U, JacquyJ, HildebrandJ, GodauxE.Recovery of hypermetria after a cerebellar stroke occurs as a multistage process. Ann Neurol 1995; 38: 437–445.
34. MantoM-U, HildebrandJ, JacquyJ.Shift from hypermetria to hypometria in an aberrant recovery following cerebellar infarction. J Neurol Sci 1998; 157: 42–51.
35. AmarencoP, RoulletE, HommelM, ChaineP, MarteauR.Infarction in the territory of the medial branch of the posterior inferior cerebellar artery. J Neurol Neurosurg Psychiatry 1990; 53: 731–735.
36. BarthA, BogousslavskyJ, RegliF.Infarcts in the territory of the lateral branch of the posterior inferior cerebellar artery. J Neurol Neurosurg Psychiatry 1994; 57: 1073–1076.
37. DelucaC, TinazziM, BoviP, RizzutoN, MorettoG.Limb ataxia and proximal intracranial territory brain infarcts: clinical and topographical correlations. J Neurol Neurosurg Psychiatry 2007; 78: 832–835.
38. AckermannH, VogelM, PetersenD, PorembaM.Speech deficits in ischemic cerebellar lesions. J Neurol 1992; 239: 223–227.
39. DuncanGW, ParkerSW, Miller FisherC.Acute cerebellar infarction in the PICA territory. Arch Neurol 1975; 32: 364–368.
40. BarthA, BogousslavskyJ, RegliF.The clinical and topographic spectrum of cerebellar infarcts: a clinical-magnetic resonance imaging correlation study. Ann Neurol 1993; 33: 451–456.
41. AmarencoP, RoulletE, GoujonC, et al. Infarction in the anterior rostral cerebellum (the territory of the lateral branch of the superior cerebellar artery). Neurology 1991; 41: 253–258.
42. SohnSI, LeeH, LeeSR, BalohRW.Cerebellar infarction in the territory of the medial branch of the superior cerebellar artery. Neurology 2006; 66: 115–117.
43. CanapleS, BogousslavskyJ.Multiple large and small cerebellar infarcts. J Neurol Neurosurg Psychiatry 1999; 66: 739–745.
44. RoquerJ, LorenzoJP, PouA.The anterior inferior cerebellar artery infarcts: a clinico-magnetic resonance imaging study. Acta Neurol Scand 1998; 97: 225–230.
45. FisherCM.Ataxic hemiparesis. A pathologic study. Arch Neurol 1978; 35: 126–128.
46. HiragaA, UzawaA, KamitsukasaI.Diffusion weighted imaging in ataxic hemiparesis. J Neurol Neurosurg Psychiatry 2007; 78: 1260–1262.
47. MoulinT, BogousslavskyJ, ChopardJL, et al. Vascular ataxic hemiparesis: a re-evaluation. J Neurol Neurosurg Psychiatry 1995; 58: 422–427.
48. GormanMJ, DaferR, LevineSR. Ataxic hemiparesis. Critical appraisal of a lacunar syndrome. Stroke 1998; 29: 2549–2555.
49. HuangCY, Lui FS. Ataxic-hemiparesis, localization and clinical features. Stroke 1984; 15: 363–366.
50. TanakaM, KondoS, HiraiS, et al. (1992). Crossed cerebellar diaschisis accompanied by hemiataxia: a PET study. J Neurol Neurosurg Psychiatry 1992; 55: 121–125.
51. LinDD, KleinmanJT, WitykRJ, et al. Crossed cerebellar diaschisis in acute stroke detected by dynamic susceptibility contrast MR perfusion imaging. AJNR Am J Neuroradiol 2009; 30: 710–715.
52. GiroudM, CreissonE, FayolleH, et al. Homolateral ataxia and crural paresis: a crossed cerebral-cerebellar diaschisis. J Neurol Neurosurg Psychiatry 1994; 57: 221–222.
53. RousseauxM, SteinlingM, MazingueA, BenaimC, FrogerJ.Cerebral blood flow in lateral medullary infarcts. Stroke 1995; 26: 1404–1408.
54. FlintAC, NaleyMC, WrightCB.Ataxic hemiparesis from strategic frontal white matter infarction with crossed cerebellar diaschisis. Stroke 2006; 37: e1–2.
55. HelgasonCM, WilburAC.Capsular hypesthetic ataxic hemiparesis. Stroke 1990; 21: 24–33.
56. BogousslavskyJ, MartinR, MoulinT.Homolateral ataxia and crural paresis: a syndrome of anterior cerebral artery infarction. J Neurol Neurosurg Psychiatry 1992; 55: 1146–1149.
57. SaitohT, KamiyaH, MizunoY, et al. Neurophysiological analysis of ataxia in capsular ataxic hemiparesis. J Neurol Sci 1987; 79: 221–228.
58. BassettiC, BogousslavskyJ, BarthA, RegliF.Isolated infarcts of the pons. Neurology 1996; 46: 165–175.
59. SchmahmannJD, KoR, MacMoreJ.The human basis pontis: motor syndromes and topographic organization. Brain 2004; 127: 1269–1291.
60. KumralE, BayülkemG, EvyapanD.Clinical spectrum of pontine infarction. Clinical-MRI correlations. J Neurol 2002; 249: 1659–1670.
61. MitomaH, HayashiR, YanagisawaN, TsukagoshiH.Gait disturbances in patients with pontine medial tegmental lesions: clinical characteristics and gait analysis. Arch Neurol 2000; 57: 1048–1057.
62. BogousslavskyJ, RegliF, GhikaJ, FeldmeyerJ-J.Painful ataxic hemiparesis. Arch Neurol 1984; 41: 892–893.
63. BogousslavskyJ, RegliF, UskeA.Thalamic infarcts: clinical syndromes, etiology, and prognosis. Neurology 1988; 38: 837–848.
64. MeloTP, BogousslavskyJ, MoulinT, NaderJ, RegliF.Thalamic ataxia. J Neurol 1992; 239: 331–337.
65. SolomonDH, BarohnRJ, BazanC, GrissomJ.The thalamic ataxia syndrome. Neurology 1994; 44: 810–814.
66. ThompsonPD, MarsdenCD.Gait disorder of subcortical arteriosclerotic encephalopathy: Binswanger's disease. Mov Disord 1987; 2: 1–8.
67. ElbleRJ, CousinsR, LefflerK, HughesL.Gait initiation by patients with lower-half parkinsonism. Brain 1996; 119: 1705–1716.
68. BronsteinAM, BrandtT, WoollacottM, NuttJG.Clinical Disorders of Balance, Posture and Gait. 2nd ed. London: Arnold, 2004.
69. NuttJG, MarsdenCD, ThompsonPD.Human walking and higher-level gait disorders, particularly in the elderly. Neurology 1993; 43, 268–279.
70. CarbonciniMC, VolterraniD, BonfiglioL, et al. Higher level gait disorders in subcortical chronic vascular encephalopathy: a single photon emission computed tomography study. Age Ageing 2009; 38: 302–307.
71. ListonR, MickelboroughJ, BeneJ, TallisR.A new classification of higher level gait disorders in patients with cerebral multi-infarct states. Age Ageing 2003; 32: 252–258.