Acute cerebellar ataxia: differential diagnosis and clinical approach

ABSTRACT Cerebellar ataxia is a common finding in neurological practice and has a wide variety of causes, ranging from the chronic and slowly-progressive cerebellar degenerations to the acute cerebellar lesions due to infarction, edema and hemorrhage, configuring a true neurological emergency. Acute cerebellar ataxia is a syndrome that occurs in less than 72 hours, in previously healthy subjects. Acute ataxia usually results in hospitalization and extensive laboratory investigation. Clinicians are often faced with decisions on the extent and timing of the initial screening tests, particularly to detect treatable causes. The main group of diseases that may cause acute ataxias discussed in this article are: stroke, infectious, toxic, immune-mediated, paraneoplastic, vitamin deficiency, structural lesions and metabolic diseases. This review focuses on the etiologic and diagnostic considerations for acute ataxia.

摘要：小脑性共济失调（cerebellar ataxia）是神经科临床常见病症，病因谱广泛，既包括慢性缓慢进展的小脑退行性病变，也涵盖由梗死、水肿、出血引发的急性小脑病变——后者属于真正的神经科急症。急性小脑性共济失调（acute cerebellar ataxia）指在既往健康人群中发病时长不足72小时的综合征。此类病症通常需患者住院并接受全面实验室检查，临床医师常需权衡初始筛查试验的范围与时机，尤其是为检出可治疗的病因。本文讨论的可引发急性共济失调的主要疾病类别包括：脑卒中、感染性疾病、中毒性疾病、免疫介导性疾病、副肿瘤性疾病、维生素缺乏性病变、结构性病变及代谢性疾病。本综述聚焦急性共济失调的病因学与诊断相关考量。