Vestibular Ataxia: Causes, Symptoms, diagnosis and Treatment

0
1427
A group of walking people that checks if they have Vestibular Ataxia

1Overview

Vestibular ataxia is a type of ataxia that results in a dysfunction of the vestibular system. The vestibular system is made up of the inner ear and ear canals that contain fluid.
They sense the movements of the head and help with the balance and spatial orientation. Vestibular ataxia results from an impairment of the inner ear.

The signals from the inner ear are not able to reach the cerebellum and the brainstem when an individual has vestibular ataxia. An individual with vestibular ataxia experiences a loss of balance with preservation of strength. A patient often experiences vertigo, a feeling that everything around you is spinning. He/she may also show loss of balance or involuntary movement of the eyes.

In unilateral or acute cases, the abnormality is asymmetrical and the patient may experience nausea, vomiting, and vertigo. In slow-onset chronic bilateral cases,
it is symmetrical and the patient may only experience dysequilibrium or unsteadiness.

2Causes

Ataxia can be caused by a wide range of factors. Vestibular, cerebellar, and sensory ataxia have overlapping causes and they can either coexist or occur in isolation.

Vestibular ataxia is commonly caused by an inflammation of the inner ear.
Another common cause of vestibular ataxia is a vestibular nerve that carries trauma, signals, lack of blood supply and some drugs that affect the inner ear. It can also be caused by a damage to the eighth cranial nerve in the inner ear.

Focal lesions

Stroke, multiple sclerosis, brain tumor and any type of focal lesion of the central nervous system causes vestibular ataxia if the lesion appears in the vestibular system which includes the vestibular areas of the cerebral cortex.

Vitamin b-12 deficiency

Lack of vitamin B-12 can potentially cause ataxia.

Gluten allergy

Allergy to gluten can cause ataxia.

Metabolic ataxia or exogenous substances

Exogenous substances such as ethanol, prescription drugs, and other recreational drugs can cause vestibular ataxia and other types of ataxia. These exogenous substances have a depressant effect on the central nervous system function. High levels of lithium and mercury can also cause ataxia and other neurological disorders. Basically, exposure to toxic chemicals causes ataxia.

Frontal lobes

Damage to the frontal lobes produces a disturbance of the gain called apraxia of gait.
The patient tends to slide their foot on the floor instead of lifting it and placing it normally on the floor. Frontal lobe strokes is a possible cause of vestibular ataxia.

Infection

The infection causes inflammation in the cerebellum that prevents it from functioning normally. Ataxia is more commonly caused by viral infections such as chickenpox but can also be caused by bacterial infections like Lyme disease. It results in an acute or sudden attack of ataxia which often affects children more than adults. It may be visible during the healing stage and may last for a couple of days or for weeks. Usually, ataxia resolves over time. Ataxia goes away after the infection has cleared.

Drug and alcohol abuse

Alcohol and drug abuse can cause different types of ataxia.

Stroke

Brain cells die when the supply of blood in an individual’s brain is severely reduced or interrupted depriving brain tissue of nutrients and oxygen.

Autoimmune diseases

Autoimmune diseases such as multiple sclerosis, celiac disease, and sarcoidosis can cause ataxia.

Hydrocephalus

The Too much fluid buildup in the brain can cause ataxia.

Problems during pregnancy

Malformation of the cerebellum, while the baby is still in the womb, can cause ataxia.

Reactions to certain cancers

Some cancers result in vestibular or other types of ataxia.

Inherited ataxia

Ataxia may be caused by a genetic defect inherited from either one of the parents or both of them.

You can inherit genetic ataxia either through a parent’s dominant gene, also known as an autosomal dominant disorder or from each parent’s recessive gene, also known as an autosomal recessive disorder.

Idiopathic ataxia

Idiopathic ataxia is ataxia that has no defined cause. Idiopathic ataxia is diagnosed by doctors when they can’t find a medical reason for the ataxia symptoms of a patient.

3Symptoms

  • Vertigo or dizziness
  • Nausea
  • Vomiting
  • Problems sitting and standing
  • Poor coordination
  • Hearing problems
  • Staggering when walking
  • Trouble walking in a straight line
  • Tremors where some parts of the body may tremble or shake unintentionally
  • Slurred speech
  • Unsteadiness
  • Vision problems
  • Loss of balance
  • Walking difficulties
  • Nystagmus or jittery eye movements – an involuntary rapid, rhythmic, and repetitive movement of the eye which is either horizontal, vertical, or circular
  • Weakness
  • Cognitive difficulties
  • Slowness or stiffness in movement
  • Abnormal movements
  • Significant changes in behavior

4diagnosis

Vestibular ataxia is diagnosed just like the other types of ataxia. It can be quite challenging as it involves a range of tests most of the time.

When a patient is suspected to have ataxia, the doctor usually refers him/her to a neurologist, a doctor who specializes in the diagnosis, treatment, and prevention of illnesses and conditions within the nervous system.

The doctor usually checks the patient’s medical history to check casual factors such as brain injury, tumors, drug and alcohol abuse, etc. and also the family’s medical history to check a possibility of ataxia of a genetic origin.

An examination is done on a patient with ataxia to evaluate the systems that are essential in maintaining an upright posture. During a neurological examination, screening tests are done to evaluate the strength, coordination, muscle tone, the vestibular system, the cortical function, and the conscious proprioceptive system. The most critical thing for a neurologist to check on a patient suspected to have ataxia is to check how the patient walks. It is also necessary to examine the patient’s posture when standing with feet together. The specific type of ataxia is determined by the doctor after evaluating the causes of the patient’s gait.

A patient with vestibular problems such as vestibular ataxia can be quite easily recognized just by checking the patient’s history and by doing an exam. Patients with vestibular ataxia are more likely to have vertigo and they will usually show nystagmus that is at least in proportion to their vertigo. When the doctor tries to make them walk in a straight line, they have a tendency to veer to one side.

Ataxia can also be diagnosed through the following tests:

  • Ataxia can be diagnosed through CT Scan or MRI to check whether there is a brain damage.
  • In case of hereditary ataxia, genetic studies and tests are run to determine whether the patient has inherited ataxia.
  • Some types of ataxia affect the composition of blood so blood tests are also run on individuals who are suspected to have vestibular ataxia.
  • Urine tests are also another way to diagnose vestibular ataxia because urinalysis might be able to detect specific systemic abnormalities that may be linked to some types of ataxia.

Reaching a final conclusion to diagnose ataxia may take a really long time because ataxia can be a symptom of underlying conditions. The symptoms of ataxia could also point to several other conditions.

5Treatment

Ataxia is generally not curable but there are some treatments and essential factors that can be applied to the patient to alleviate the symptoms and improve the quality of life of the patient. There is no specific treatment for vestibular ataxia. In some instances, patients can recover spontaneously but in some cases, other patients can undergo further complications.

Adaptive devices like a walking stick or a cane, walker, wheelchair or crutches are used to assist patients with coordination and balance problems to help them attain as much independence as possible.

Other symptoms such as muscle weakness, sleep disorders, and depression, can be addressed through therapy, counseling, and medications. These therapies can help patients cope with their symptoms.

  • Speech therapy – The speech therapist can assist the patient with coughing, swallow, choking, and speech problems. The speech therapist can also help the patient in learning how to use speech aids if speech becomes very difficult.
  • Physical therapy – A physical therapist can help maintain the strength of the patient and also improve his/her mobility.
  • Occupational therapy – The occupational therapist can assist the patient in managing to go around the house or at work. He/she can give advice on home adaptations, make some wheelchair assessments, or even make the kitchen more practical for the patient.
  • Orthopedic care – This can help ease patients with scoliosis.
  • Counseling – Patients diagnosed with ataxia usually get depressed or frustrated because of their condition preventing them to do the things that they want to do physically. It can be caused by them having to cope with symptoms of their condition that can affect their coordination and physical mobility. A psychotherapist or a well-qualified counselor can help the patient with depression.
  • Nutrition and supplements – One of the causes of ataxia is the lack of Vitamin E or B12. Patients with low levels of these vitamins need to take in supplements and are required to have a special diet. Some patients with ataxia may be sensitive to gluten so having a gluten-free diet may help.
  • Medication – Medicines may be needed not necessarily to treat vestibular ataxia itself but to treat the symptoms such as dizziness or vertigo.