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Cognitive Impairment - Cerebellar Ataxia
CIAT

Presentation

=71, ALLELE2=23) Signs suggestive of PD diagnosis Asymmetric onset present absent Bradykinesis present absent Activation tremor present absent Resting Tremor present absent Postural Instability present absent Rigidity present absent Gait difficulties [catalog.coriell.org]

Occasionally patients will present with late-onset forms of this disease. [neuroweb.us]

Patients typically present with a wide-based gait, truncal instability, and dysarthria. [healio.com]

Autonomic dysfunction, vasomotor symptoms, and REM sleep disorder may also be present. [amjmed.org]

These patients present with gait ataxia usually with headache and papilledema. Progressive hydrocephalus can also present with subacute-onset ataxia. [jpgmonline.com]

Entire Body System

  • Weakness

    There are several very specific gait disturbances associated with weakness. For example, weakness of the hip girdle muscles causes the pelvis to shift toward the side of weakness when walking. [dartmouth.edu]

    progressive weakness (defects of mitochondrial protein transport), 4) affecting both muscle and brain; myopathy with exercise intolerance, myoglobinuria, progressive weakness, ataxia and seizures, increased serum CK and ragged-red fibers on muscle biopsy [neuroweb.us]

    However, weakness, a key feature of CMD, was not a finding. In addition, no mutations were found within the known dystroglycanopathy genes. [thieme-connect.com]

    Children may experience severe pain in the lower extremities or back prior to the onset of weakness. 30 Weakness and ataxia reach a nadir within 4 weeks. Rare instances may progress to involvement of the respiratory muscles and quadriparesis. [healio.com]

    Friedreich's ataxia (FRDA), the most frequent inherited ataxia, is an autosomal recessive disease which begins usually before age 20 with gait ataxia, proprioceptive and superficial sensory loss, weakness and atrophy of the extremities, and spasticity [neuropathology-web.org]

  • Whipple Disease

    Cerebellar ataxia and central nervous system whipple disease. Arch Neurol 2005;62:618-20. 33. Quinn N. Rhythmic tremor of the palate and other cranial limb muscles, with cerebellar ataxia: Consider Whipple's disease. Mov Disord 2001;16:787. 34. [jpgmonline.com]

    Whipple disease : This rare disorder is predominantly found in middle-aged men. [neuroweb.us]

Musculoskeletal

  • Muscle Weakness

    As the disease progresses, speech and swallowing difficulties, muscle spasms and stiffness, eye muscle weakness and involuntary movement and cognitive impairment often occur. [medicalmarijuanainc.com]

    Vitamin B12 deficiency causes sensory ataxia in addition to muscle weakness. Treatment Of all the movement disorders, ataxia is among the most resistant to medical therapy. Clonazepam may help tremor and balance problems. [bcm.edu]

    progressive weakness (defects of mitochondrial protein transport), 4) affecting both muscle and brain; myopathy with exercise intolerance, myoglobinuria, progressive weakness, ataxia and seizures, increased serum CK and ragged-red fibers on muscle biopsy [neuroweb.us]

  • Muscular Atrophy

    atrophy Dementia is defined as a global cognitive and functional decline in the presence of a clear sensorium. [hopkinsguides.com]

Psychiatrical

  • Dyslexia

    A study of people with dyslexia showed lower activation via positron emission tomography (PET) in the cerebellum during a motor task relative to a control group. [16] It may be possible to further understand the pathology of these psychiatric disorders [en.wikipedia.org]

Neurologic

  • Dysmetria

    Features include bilateral esophoria, strabismatic amblyopia, unsustained gaze evoked nystagmus on horizontal gaze, ataxic gait, dysmetria in the upper limbs and dysarthria, with normal strength, tone, and reflexes. [malacards.org]

    The role of the cerebellum in cognition and emotion: Personal reflections since 1982 on the dysmetria of thought hypothesis, and its historical evolution from theory to therapy. [en.wikipedia.org]

    The clinical findings of cerebellar dysfunction (dysarthria, bilateral dysmetria, dysdiadochokinesia, intention tremor, ataxic gait) improved markedly. [em-consulte.com]

    It seems likely that the predictive and preparative function of the cerebellum can lead to two types of dysmetria; one in motor functions and one in cognitive functions. [jnnp.bmj.com]

    Neurologic examination was remarkable for dysmetria, dysdiadochokinesia, and wide-based, unsteady gait. Aside from orthostatic hypotension, the remaining examination was benign. [amjmed.org]

  • Personality Change

    They are likely to have signs of personality change or cognitive change (the latter especially if the frontal lobe dysfunction is part of a more generalized cortical dysfunction). [dartmouth.edu]

    In the ensuing years, the patient showed increasing cognitive impairment as well as personality changes, becoming increasingly aggressive. He gave up work. His GP referred him for outpatient assessment in a geriatric psychiatric unit. [tidsskriftet.no]

    Personality changes manifest as blunting of affect or disinhibited and inappropriate behavior. [en.wikipedia.org]

    Previous studies have shown that impaired spatial cognition (visuospatial organization and memory), executive function (planning, set shifting, verbal fluency, abstract reasoning, and working memory), personality changes, and language deficits (agrammatism [e-jmd.org]

    MRI tends to be normal or shows mild, non-specific changes. Acute Cerebellitis Acute cerebellitis may occur after a systemic illness or be the direct result of infection in the cerebellum. [healio.com]

  • Apraxia

    At a mean age of 7.2 years (range 3.5 to 13.5 years), cognitive impairment and ataxia were found in all patients, ocular motor apraxia in six, and severe myopia in three. [thieme-connect.com]

    […] caused by mutations in ATM Ataxia with vitamin E deficiency (AVED), caused by mutations in TTPA Ataxia with oculomotor apraxia type 1 (AOA1) caused by mutations in APTX Ataxia with oculomotor apraxia type 2 (AOA2) caused by mutations in SETX POLG (polymerase [centogene.com]

    The classic gait of frontal lobe disease is “apraxia.” This consists of a gait in which the person slides their feet along the floor (“magnetic” or “glue-footed”). [dartmouth.edu]

    Frequency and phenotypic spectrum of ataxia with oculomotor apraxia 2: a clinical and genetic study in 18 patients. Brain. 2004;127:759-67. Lock RJ, Tengah DP, Williams AJ, et al. [bcm.edu]

    Chorea/dystonia are seen in Huntington's disease, DRPLA, ataxia telangiectasia, ataxia with oculomotor apraxia Type 1 and 2, Friedreich's ataxia, and Wilson's disease. [jpgmonline.com]

  • Aphasia

    MalaCards based summary : Cognitive Impairment with or Without Cerebellar Ataxia, also known as ciat, is related to aphasia. [malacards.org]

    A verbal analysis test revealed her word comprehension and expression remained intact and she had no sign of aphasia, but mild to moderate signs of cerebellar dysarthria. [io9.gizmodo.com]

    «Atypical progressive supranuclear palsy underlying progressive apraxia of speech and nonfluent aphasia». Neurocase (núm. 11, págs. 283-296). Lee, W.; Williams, D. R.; Storey, E. (2012). [cv.uoc.edu]

  • Motor Disturbances

    The attentional deficits show once again that the deficits cannot be only due to motor disturbances. [jnnp.bmj.com]

    Kufs disease should be considered when seizures and motor disturbances complicate the early course of atypical dementia in middle adult life. [neuroweb.us]

Workup

Other Pathologies

  • Gliosis

    Neurodegeneration in the cerebellum is characterized by marked Purkinje cell loss, gliosis and axonal swelling. Furthermore, elevated FMR1 mRNA levels seen in premutation carriers have been implicated by way of a neurotoxic gain of function effect. [radiopaedia.org]

    Microscopic examination of these structures reveals neuronal loss, axon and myelin degeneration, and gliosis. Similar changes are seen in autonomic nuclei of the hypothalamus, brainstem and spinal cord and in many other nuclei. [neuropathology-web.org]

    In pernicious anemia there may be early localized or relatively diffuse cord swelling with increased T2 SI that is most evident in the posterior columns. 35 Late atrophy and persistent gliosis may develop, or all findings may resolve with treatment. 35 [ajnr.org]

Treatment

Medical Complications of Drug Use 840 Acute and Chronic Pain 863 Substance Use Disorders in Individuals with CoOccurring Psychiatric Disorders 904 Epidemiology and Emerging Public Health Perspectives 913 HIVRelated Medical Complications and Treatment [books.google.com]

Seventeen states have approved medical marijuana for the treatment of spasms, which are commonly associated with spinocerebellar ataxia. [medicalmarijuanainc.com]

The symptoms are similar to those of other conditions, making it difficult to diagnose and get ahead on the preventative treatment. [mmjrecs.com]

[ edit ] The current treatments for CCAS focus on relieving the symptoms. [en.wikipedia.org]

Prognosis

[…] premutation carriers with FXTAS axial and radial diffusivity values in the middle cerebellar peduncle and cerebral peduncle have been shown to be increased in asymptomatic premutation carriers, without alteration in fractional anisotropy 5 Treatment and prognosis [radiopaedia.org]

Prognosis Spinocerebellar ataxias due to repeat expansion mutations usually become sick in middle age. In addition to ataxia, other neurological findings are often present depending on the variant of SCA. [verywell.com]

Management and prognosis This depends upon the underlying cause. [patient.info]

The prognosis is usually bad with survival rates less than a few years after onset. [neuroweb.us]

Etiology

Code First Code First Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10data.com]

The remainder of the review discusses etiological considerations that vary depending on the age group under consideration. [healio.com]

Initially, we found no family history, no exposure history, and nothing else suggestive of an alternative etiology. [amjmed.org]

Cause [ edit ] The causes of CCAS lead to variations in symptoms, but a common core of symptoms can be seen regardless of etiology. [en.wikipedia.org]

Epidemiology

Medical Complications of Drug Use 840 Acute and Chronic Pain 863 Substance Use Disorders in Individuals with CoOccurring Psychiatric Disorders 904 Epidemiology and Emerging Public Health Perspectives 913 HIVRelated Medical Complications and Treatment [books.google.com]

Gluten ataxia in perspective: epidemiology, genetic susceptibility and clinical characteristics. Brain. 2003;126:685-91. Hou J-G, Jankovic J. Movement disorders in Friedreich's ataxia. J Neurol Sci. 2003;206:59-64. Jankovic J, Tolosa E, eds. [bcm.edu]

Molecular epidemiology and clinical spectrum of hereditary spastic paraplegia in the Japanese population based on comprehensive mutational analyses. J Hum Genet 2014; 59 : 163–172. [nature.com]

A population-based epidemiological study in Japan showed no reports of SCA10 cases [ 12 ]. [journals.plos.org]

Epidemiological Study of Dystonia in Europe (ESDE) (2000). «A prevalence study of primary dystonia in eight European countries». Journal of Neurology (vol. 10, núm. 247, págs. 787-792). [cv.uoc.edu]

Pathophysiology

The neuropathology, pathophysiology and genetics of multiple system atrophy. Neuropathol Appl Neurobiol. 2012;38:4-24. PubMed Koeppen AH, Mazurkievicz JE. Friedreich Ataxia: Neuropathology Revised. J Neuropathol Exp Neurol 2013;72(2):78-90. [neuropathology-web.org]

Instead they may be both long lasting and potentially damaging. 12 Stress, sleep disruption, exercise and inflammation have all been linked with regulating hippocampal neurogenesis and implicated in the pathophysiology of mood disorders. 13 But can gluten [thepaleodiet.com]

«The pathophysiology of primary dystonia». Brain (núm. 121, págs. 1195-1212). Bihari, K.; Hill, J. L.; Murphy, D. L. (1992). «Obsessive-compulsive characteristics in patients with idiopathic spasmodic torticollis». [cv.uoc.edu]

Most cases follow severe injuries; 20 however, a few children have been noted to have cerebellar concussion following relatively minor head trauma. 21 The pathophysiology is believed to be damage to the connections between the cerebellum and the cortex [healio.com]

In precedent works [ 27 - 29, 31, 32 ], we demonstrated the involvement of the thalamus in the pathophysiological mechanisms of RR-MS as evidenced in other works [ 33 - 35 ]. [omicsonline.org]

Prevention

[…] and Treatment of Addiction Among African Americans 1250 The Public Health Approach to the Prevention of Substance Abuse 1255 Medical Education in Substance Abuse The Acquisition of Knowledge Attitudes and Skills 1269 Education and Training of Clinical [books.google.com]

Health promotion and disease prevention in clinical practice Coviello, Jessica Shank. Third edition. Philadelphia : Wolters Kluwer, [2020] NLM ID: 101738883 [Book] Select item 101739755 3. [ncbi.nlm.nih.gov]

Other clues to abnormal extrapyramidal function include abnormal movements at rest and slowed eye movements (some conditions prevent voluntary vertical eye movements). [dartmouth.edu]

The symptoms are similar to those of other conditions, making it difficult to diagnose and get ahead on the preventative treatment. [mmjrecs.com]

A major cannabinoid found in cannabis, tetrahydrocannabinol (THC), has been shown to help in the treatment of Parkinson’s disease by preventing free radical damage and encouraging the formation of new mitochondria (Zeissler, et al., 2013). [medicalmarijuanainc.com]

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