What is Ataxia?

When Is Being Clumsy A Medical Problem?

Human Brain
Human Brain. ulton Archive / Stringer / Getty Images

Ataxia is the scientific term for a lack of coordination or clumsiness. The part of the brain most commonly associated with coordination is the cerebellum. Lesions due to tumors, stroke or multiple sclerosis that damage the cerebellum, or nerve fibers communicating with the cerebellum, can lead to difficulty moving with precision. This can lead to problems with speaking, swallowing, and walking as well.

An easy way to picture what ataxia looks like is to imagine someone who drank far too much alcohol. Alcohol directly impacts the cerebellum. The stumbling walk, fumbling with their hands, and slurring of their speech is all due to ataxia caused by the alcohol.

Terminology

Technical terms for the various aspects of ataxia include:

  • Dysmetria- an inability to correctly judge distance. A neurologist may test for dysmetria by asking someone to point to their nose, and then to the neurologist's finger. If the patient reaches too far or not far enough, dysmetria is present.

  • Dysrhythmia- an inability to move in a steady rhythm.

  • Dysdiadochokinesia- pronounced "dis-die-add-ik-ko-kin-EE-she-ah", this term means that someone can't quickly move something back and forth. A neurologist can test this by asking a patient to repeatedly slap their hand over and back on top of their opposite hand as quickly as possible.

  • Dysarthria- difficulty speaking. Cerebellar lesions can cause what is described as "scanning" speech, meaning speech that is slowed and that emphasizes incorrect syllables.

  • Dysphagia- difficulty swallowing. This can be caused by a lot of things other than cerebellar problems as well.

  • Titubation- an unsteady tremor of the torso and/or head which can be seen in people with cerebellar diseases.

    Other forms of ataxia include sensory ataxia, in which clumsiness is due to a loss of sensation of where the body is in space (proprioception). This can be checked by someone else moving the patient's finger or toe up and down, and asking the patient if they can detect the difference. In vestibular ataxia, clumsiness results from a disorder leading to dizziness. It is not uncommon for a person to have more than one type of ataxia at a time.

    Causes of Ataxia

    Ataxia can be caused by many different things. As we've discussed, anything that damages the cerebellum can lead to ataxia, including tumors or stroke. Other causes of ataxia include:

    Tests for Ataxia

    Which tests are used in an evaluation for ataxia will depend on on the individual patient. If there is a strong family history, it may be most efficient to just start with genetic tests for spinocerebellar ataxia.

    An MRI is a good idea to rule out causes of acquired ataxia like a tumor, stroke, or multiple sclerosis. In some neurodegenerative ataxia, like spinocerebellar ataxia, parts of the brain like the cerebellum and brainstem may have shrunken. If there is a sense that an infection or autoimmune process behind the ataxia, a lumbar puncture may be advised as well.

    Treatment of Ataxia

    As is often the case, the treatment for ataxia depends on determining the exact underlying cause. However, physical therapy can be very helpful in helping people cope with the clumsiness and poor balance caused by ataxia. Use of mobility aids like a walker or cane may be necessary in some cases.

    Sources:

    Hal Blumenfeld, Neuroanatomy through Clinical Cases. Sunderland: Sinauer Associates Publishers 2002

    AH Ropper, Samuels MA. Adams and Victor's Principles of Neurology, 9th ed: The McGraw-Hill Companies, Inc., 2009.

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