Cerebellum brain disease symptoms treatment. Inflammatory diseases of the cerebellum

In diseases of the cerebellum, three groups of symptoms appear: 1) depending on the damage to the tissue of the cerebellum itself; 2) from the involvement in the process of formations located near the cerebellum within the posterior cerebral fossa (stem syndrome and dysfunction of the cranial nerves); 3) from involvement in the process of supratentorially located departments of the central nervous system. When the neocerebellar regions are affected, cerebellar symptoms develop, and when the so-called vestibular regions are affected, cerebellar-vestibular symptoms develop. With the progression of a local lesion (tumor), cerebellar-vestibular symptoms are the result of damage to the cerebellar tissue only in the initial stages of the disease; in the future, they mostly arise due to the involvement in the process of the central vestibular formations located in the brain stem regions.

Cerebellar symptoms include cerebellar hypotension, impaired coordination of limb movements, cerebellar rifling (asthenia, adynamia), hyperkinesis (tremor and myoclonus), speech disorders of cerebellar origin; to the cerebellar-vestibular - violations of statics and gait, Babinsky's asynergy.

Cerebellar hypotension. The severity of muscular hypotension increases in accordance with the increase in damage to the cerebellar cortex and, possibly, with the involvement of the dentate nucleus in the process. The increase in tone and its complex irregular distributions, which are sometimes observed with damage to the cerebellum, are largely associated with the involvement of stem formations in the process.

Disturbance of coordination of movements of extremities. The term cerebellar ataxia (in relation to specialized movements of the limbs) combines a number of symptoms indicating a violation of the regulation of motor acts, their coordination. These symptoms include: a violation of the range of a motor act (dysmetria, hypermetry, hypometry), errors in its direction, a violation of the pace (slowness). Impaired coordination of movements is one of the components of the hemispheric cerebellar syndrome. At the same time, it is more clearly detected in the upper limbs, which is associated with the special development in humans of fine specialized asymmetric movements of the upper limbs.

Cerebellar paresis (asthenia, adynamia). With damage to the cerebellum in acute and chronic forms of the disease, a decrease in muscle strength is observed homo-lateral to the lesion and is a consequence of impaired tone.

Hyperkinesis. With lesions of the cerebellum, the following types of hyperkinesis occur: 1) ataxic, or dynamic, tremor that appears with active movements in the limbs; it includes the so-called intentional tremor, which increases when the goal is reached; 2) myoclonus - rapid twitching of individual muscle groups or muscles observed in humans in the limbs, neck and swallowing muscles. Choreic-athetotic movements in the limbs with lesions of the cerebellum are rare; they are associated with the involvement of the systems of the dentate nucleus in the process. Also, twitching in the muscles of the neck and myoclonus of the soft palate and pharyngeal walls rarely occur. Myoclonus occurs when stem formations are involved in the process.

Speech disorders in diseases of the cerebellum are observed in three forms: cerebellar bradilalia and scanned speech, bulbar, mixed. With bulbar disorders, expressed even in a mild degree, it is difficult to decide whether in this case, in addition to them, speech disorders are also of cerebellar origin. Only in rare cases, with mild symptoms of damage to the IX and X pairs of cranial nerves, the severity of scanned speech can suggest its cerebellar origin. In scanned speech, the stresses are not placed according to the meaning, but are separated by even intervals.

Static and gait disorders that occur in patients with cerebellar disease may be the result of damage to the cerebellar-vestibular formations located in the cerebellum, as well as vestibular formations located in the brain stem. At the same time, statokinetic disorders can be of varying intensity - from a barely noticeable stagger when standing, walking (with a slight spread of the legs) to pronounced forms of trunk ataxia, when the patient is able to neither stand nor sit and falls back or to the side without support. Significant gait disturbances include a staggering, wide-legged gait, zigzag swaying, or swaying in a certain direction from a given direction; at the same time, the impression of “drunk gait” is often created.

Asynergy (or dyssynergy) is the impossibility of simultaneous joint, or synergistic, execution of a complex movement. If a healthy person is laid on his back with crossed arms and offered to take a sitting position, he will do this without difficulty, since simultaneously with the bending of the body, the legs and pelvis are fixed to the support plane. A patient with asynergy cannot do this, because due to the lack of synergy of the muscle groups that bend the torso and fix the pelvis and lower limbs, both legs rise instead of the torso, or one leg on the side of the lesion.

From point of view anatomical location of the cerebellum directly adjacent to the brain stem and connected to it with the help of its three legs.
The cortex and nuclei of the cerebellum contain ganglion cells that carry out the function of processing information and sending impulses.
Information about the position of body parts and muscle activity enters the cerebellum through the lower cerebellar peduncle (corpus restiforme) and partially through the superior cerebellar peduncle (brachium conjunctivum).

Vestibular impulses, carrying information about the position of the head in space and its movements, enter the cerebellum through the lower peduncle.
Impulses coming from the cerebrum and having switching in the nuclei of the bridge enter the cerebellum through the middle cerebellar peduncle (brachium pontis).
The information that is processed in the cerebellar cortex passes in the form of impulses through the nuclei of the cerebellum (and olive), through the superior pedicle to the red nucleus and the ventralateral nucleus of the thalamus of the opposite side. After switching in the thalamus and the red nucleus, these impulses reach the cerebral cortex or enter the muscles through the rubrospinal tract of the anterior horns of the spinal cord. Thus, the cerebellum is included in the regulation system, which ensures the harmony and coordination of movements.

These structures shown in the figure. They are responsible for the receipt of information, on the one hand, about motor impulses, on the other hand, about the state of the motor apparatus, allowing the cerebellum to constantly conduct a comparative analysis of the movement plan with its implementation and control the motor function using a feedback mechanism. Separate parts of the body have a topical representation in the cerebellar cortex. The cerebellum is supplied with blood from branches of the vertebral and basilar arteries (posterior inferior, anterior inferior and superior arteries of the cerebellum).

Cerebellar syndromes are characterized by the following common features:
decreased muscle tone;
deviation of arbitrary movements from a harmonious ideal line;
violation of automatic movements.

In some cases, they may the following symptoms are observed:
dyssynergy (lack of coordination of the muscles or muscle groups involved in the movement):
dysmetria (impaired ability to correctly determine the required amplitude and pace of movement);
ataxia (violation of the harmonious well-functioning work of the muscles to achieve the goal of movement, resulting in a lack of accuracy and smoothness of movement);
intentional tremor (increasing deviation from the main line of movement as you approach the goal of movement);

Pathological rebound phenomenon (if suddenly the resistance directed against a group of tense muscles disappears, the antagonist muscles do not have time to “turn on” to inhibit the excess movement);
dysdiadochokinesis (fast and smooth sequential movements of the agonist and antagonist muscles become impossible);
hypotension (detected during passive movements, for example, "shaking" the limb);
deviation in the positional test and miss in the Barani test on the side of the focus;
uncertainty when standing in the Romberg position;

Torso ataxia in sitting position;
unsteady gait with legs wide apart;
nystagmus (especially installation nystagmus on the side of the lesion);
speech disorder in the form of fragmentary, scanned speech.

to the most frequent etiological factors of cerebellar lesions relate:
degenerative diseases - systemic atrophies, such as olivopontocerebellar atrophy;
genetically determined metabolic disorders (for example, Louis-Bar ataxia-telangiectasia, Hartnap's disease, paroxysmal familial ataxia, abetalipoproteinemia or Bassen-Kornzweig disease, gangliosidosis with hexosaminidase A deficiency);
infectious diseases, such as infectious mononucleosis (a form of acute cerebellar ataxia of childhood), kuru (slow viral infection);
acute poisoning with transient damage to the cerebellum (for example, diphenylhydantoin);

Acquired metabolic disorders, such as hypercalcemia or cholestasis, or a condition after resection of the small intestine, accompanied by vitamin E deficiency;
symptomatic atrophy (of the cortex) of the cerebellum with toxic damage (eg, alcohol, diphenylhydantoin, organic mercury salts), with malabsorption, for example, due to sprue, with paraproteinemia, or with malignant tumors (especially bronchial carcinoma);
multiple sclerosis (foci in the substance of the cerebellum or its pathways);
rarely - circulatory disorders and massive hemorrhages in the cerebellum;

Foci in the transition area from the upper to the middle third of the peduncle of the bridge, the cerebellar lesion develops suddenly and is accompanied by hemiparesis;
tumors (medulloblastoma and spongioblastoma [cerebellar astrocytoma] in adolescents, glioma, cerebellopontine angle tumors);
abscess;
also described are relapsing forms of cerebellar damage, individual cases in multiple sclerosis and more frequent in familial episodic ataxia.

Cerebellar stroke is less common than other forms of cerebrovascular pathology, but it is a significant problem due to insufficient knowledge and diagnostic difficulties. The proximity of the location of the brain stem and vital nerve centers make this localization of strokes very dangerous and requiring quick qualified assistance.

Acute circulatory disorders in the cerebellum constitute infarctions (necrosis) or hemorrhages, which have similar mechanisms of development with other forms of intracerebral strokes, so the risk factors and underlying causes will be the same. Pathology occurs in middle-aged and elderly people, more often found among men.

Cerebellar infarction accounts for about 1.5% of all intracerebral necrosis, while hemorrhages account for a tenth of all hematomas. Among strokes, it is the cerebellar localization that accounts for about ¾ of infarcts. Mortality is high and in other cases exceeds 30%.

Causes of cerebellar stroke and its varieties

The cerebellum, as one of the parts of the brain, needs good blood flow, which is provided by the vertebral arteries and their branches. The functions of this part of the nervous system are reduced to coordination of movements, ensuring fine motor skills, balance, the ability to write and correct orientation in space.

In the cerebellum are possible:

infarction (necrosis);
Hemorrhage (formation of a hematoma).

Violation of blood flow through the vessels of the cerebellum entails either blockage, which happens much more often, or rupture, then the result will be a hematoma. The peculiarities of the latter are considered not to be the impregnation of the nervous tissue with blood, but the increase in the volume of convolutions that push the parenchyma of the cerebellum apart. However, one should not think that such a development of events is less dangerous than brain hematomas that destroy an entire area. It must be remembered that even with the preservation of part of the neurons, an increase in the volume of tissue in the posterior cranial fossa can lead to death due to compression of the brain stem. Often it is this mechanism that becomes decisive in the prognosis and outcome of the disease.

types of strokes

Ischemic stroke of the cerebellum, or heart attack, arises for a reason that feeds the organ. Embolism is most common in patients suffering from cardiac pathology. Thus, there is a high risk of thromboembolic occlusion of the cerebellar arteries in atrial fibrillation, recent or acute myocardial infarction. Intracardiac thrombi with arterial blood flow enter the vessels of the brain and cause their blockage.

Thrombosis of the arteries of the cerebellum is most often associated with when there is an overgrowth of fatty deposits with a high probability of plaque rupture. With arterial hypertension during a crisis, so-called fibrinoid necrosis of the walls of the arteries is possible, which are also fraught with thrombosis.

Hemorrhage in the cerebellum although it is less common than a heart attack, it brings more problems due to tissue displacement and compression of surrounding structures with excess blood. Usually, hematomas occur through fault when, against the background of high pressure figures, the vessel "bursts" and blood rushes into the cerebellar parenchyma.

Among other reasons, it is possible that they form even during fetal development and go unnoticed for a long time, since they are asymptomatic. There have been cases of cerebellar stroke in younger patients associated with dissection of a section of the vertebral artery.

The main risk factors for cerebellar strokes are also identified:

Diabetes;
Arterial hypertension;
Old age and male gender;
Physical inactivity, obesity, metabolic disorders;
Congenital pathology of the vascular walls;
Pathology of hemostasis;
Heart disease with a high risk of thrombosis (heart attack, endocarditis, prosthetic valve).

How does a cerebellar stroke manifest?

The manifestations of a cerebellar stroke depend on its scale, therefore, the clinic distinguishes:

Major stroke;
Isolated in the area of a specific artery.

Isolated stroke of the cerebellum

Isolated stroke part of the hemisphere of the cerebellum, when the blood supply from the posterior inferior cerebellar artery is affected, it is manifested by a complex of vestibular disorders, the most common of which is dizziness. In addition, patients experience pain in the occipital region, complain of nausea and impaired gait, speech suffers.

Heart attacks in the area of the anterior inferior cerebellar artery are also accompanied by disorders of coordination and gait, fine motor skills, speech, but among the symptoms appear hearing impairment. With damage to the right hemisphere of the cerebellum, hearing is impaired on the right, with left-sided localization - on the left.

If the superior cerebellar artery is affected, then symptoms will predominate coordination disorders, it is difficult for the patient to maintain balance and perform precise purposeful movements, the gait changes, dizziness and nausea are disturbing, there are difficulties in pronouncing sounds and words.

With a large focus of damage to the nervous tissue, the bright symptoms of disorders of coordination and motor skills immediately prompt the doctor to think about a cerebellar stroke, but it happens that the patient is only worried about dizziness, and then the diagnosis includes labyrinthitis or other diseases of the vestibular apparatus of the inner ear, which means that the correct treatment will not start on time. With very small foci of necrosis, the clinic may not be at all, since the functions of the organ are quickly restored, but about a quarter of cases of extensive heart attacks are preceded by transient changes or “small” strokes.

Massive cerebellar stroke

Major stroke with damage to the right or left hemisphere is considered an extremely serious pathology with a high risk of death. It is observed in the area of blood supply to the superior cerebellar artery or the posterior inferior when the lumen of the vertebral artery is closed. Since the cerebellum is supplied with a good network of collaterals, and all three of its main arteries are interconnected, cerebellar symptoms almost never occur in isolation, and stem and cerebral symptoms are added to it.

An extensive stroke of the cerebellum is accompanied by an acute onset with cerebral symptoms (headache, nausea, vomiting), disorders of coordination and motor skills, speech, balance, in some cases there are respiratory and cardiac disorders, swallowing due to damage to the brain stem.

If a third or more of the volume of the cerebellar hemispheres is damaged, the course of a stroke can become malignant, due to severe edema of the necrosis zone. An increased volume of tissue in the posterior cranial fossa leads to compression of the cerebrospinal fluid circulation pathways, an acute one occurs, and then compression of the brain stem and death of the patient. The probability of death reaches 80% with conservative therapy, so this form of stroke requires an emergency neurosurgical operation, but even in this case, a third of patients die.

It often happens that after a short-term improvement, the patient's condition becomes severe again, focal and cerebral symptoms increase, body temperature rises, coma is possible, which is associated with an increase in the focus of cerebellar tissue necrosis and involvement of brainstem structures. The prognosis is unfavorable even with surgical care.

Treatment and consequences of cerebellar stroke

Treatment of cerebellar stroke involves general measures and targeted therapy for ischemic or hemorrhagic type of damage.

General activities include:

Maintaining breathing and, if necessary, artificial ventilation of the lungs;
Antihypertensive therapy with beta-blockers (labetalol, propranolol), ACE inhibitors (captopril, enalapril) is indicated for hypertensive patients, the recommended blood pressure is 180/100 mm Hg. Art., since a decrease in pressure can cause a shortage of blood flow in the brain;
Hypotensive patients need infusion therapy (sodium chloride solution, albumin, etc.), it is possible to administer vasopressor drugs - dopamine, mezaton, norepinephrine;
When fever shows paracetamol, diclofenac, magnesia;
To combat cerebral edema, diuretics are needed - mannitol, furosemide, glycerol;
Anticonvulsant therapy includes Relanium, sodium hydroxybutyrate, in case of ineffectiveness of which the anesthesiologist is forced to introduce the patient into anesthesia with nitrous oxide, sometimes muscle relaxants are required for severe and prolonged convulsive syndrome;
Psychomotor agitation requires the appointment of Relanium, fentanyl, droperidol (especially if the patient needs to be transported).

Simultaneously with drug therapy, nutrition is being established, which in the case of severe strokes is more expedient to be carried out through a probe, which allows not only to provide the patient with the necessary nutrients, but also to avoid food entering the respiratory tract. At the risk of infectious complications, antibiotics are indicated. The clinic staff monitors the condition of the skin and prevents the appearance of bedsores.

Specific therapy for ischemic strokes is aimed at restoring blood flow with the help of anticoagulants, thrombolytics and through the surgical removal of blood clots from the artery. Urokinase, alteplase are used for thrombolysis, acetylsalicylic acid (thromboASS, cardiomagnyl) is the most popular among antiplatelet agents, and anticoagulants used are fraxiparin, heparin, sulodexide.

Antiplatelet and anticoagulant therapy contribute not only to the restoration of blood flow through the affected vessel, but also to the prevention of subsequent strokes, so some drugs are prescribed for a long time. Thrombolytic therapy is indicated as soon as possible from the moment of vessel occlusion, then its effect will be maximum.

With hemorrhages, the drugs listed above should not be administered, since they will only increase bleeding, and specific therapy involves maintaining acceptable blood pressure numbers and prescribing neuroprotective therapy.

It is difficult to imagine stroke treatment without neuroprotective and vascular components. Patients are prescribed nootropil, cavinton, cinnarizine, aminofillin, cerebrolysin, glycine, emoxipin and many other drugs, vitamins of group B are indicated.

Questions of surgical treatment and its effectiveness continue to be discussed. Undoubtedly, there is a need for decompression in case of a threat of dislocation syndrome with compression of the brain stem. With extensive necrosis, trepanation and removal of necrotic masses from the posterior cranial fossa are performed, with hematomas, blood clots are removed both during open operations and through endoscopic techniques, it is also possible to drain the ventricles when blood accumulates in them. To remove blood clots from the vessels, intra-arterial interventions are performed, and to ensure blood flow in the future, stenting is performed.

Recovery after a cerebellar stroke should be started as early as possible, that is, when the patient's condition stabilizes, there will be no threat of cerebral edema and repeated necrosis. It includes medication, physiotherapy, massage, and special exercises. In many cases, patients need the help of a psychologist or psychotherapist, the support of family and loved ones is important.

The recovery period requires diligence, patience and effort, because it can stretch for months and years, but some patients manage to regain lost abilities even after a few years. To train fine motor skills, exercises such as tying a shoelace, threading a knot, rotating small balls with your fingers, crocheting or knitting can be useful.

The consequences of cerebellar strokes are very serious. In the first week after a stroke, there is a high probability of brain edema and dislocation of its departments, which most often causes early death and determines a poor prognosis. In the first month, complications include pulmonary embolism, pneumonia, and cardiac pathology.

If it is possible to avoid the most dangerous consequences in the acute phase of a stroke, then most patients then face such problems as persistent incoordination, paresis, paralysis, and speech disorders that can persist for years. In rare cases, speech is still restored within a few years, but motor function, which could not be returned in the first year of the disease, most likely will not be restored.

After cerebellar strokes, it includes not only taking medications that improve the trophism of the nervous tissue and repair processes, but also exercise therapy, massage, and speech training classes. It is good if there is an opportunity for the constant participation of competent specialists, and even better if rehabilitation is carried out in a special center or sanatorium, where experienced personnel work and there is appropriate equipment.

Inflammatory diseases of the cerebellum usually occur in the background of disease of the whole brain, and the symptoms of cerebellar involvement are components of the overall clinical picture of CNS involvement. There are the following three forms of inflammatory diseases of the brain and its membranes with predominant localization of the process in the posterior cranial fossa, manifested by symptoms of meningoencephalitis: 1) with the presence of occlusion at the level of the posterior cranial fossa; 2) with the manifestation of a moderately pronounced syndrome of increased intracranial pressure, but without threatening occlusive seizures; 3) without pronounced symptoms of increased intracranial pressure.

In chronic inflammatory processes in the brain and its membranes with occlusion at the level of the posterior cranial fossa, a productive inflammatory process expressed to varying degrees in the pia mater and chronic periventricular encephalitis with internal dropsy are detected. In the region of the median opening of the ventricle (apertura mediana ventriculi quarti), proliferation of adhesions and often fusion of dense adhesions of the tonsils of the cerebellum between themselves and the brain stem are revealed. In the cavity of the IV ventricle, the growths, spreading, spread from the bottom of the rhomboid fossa to the hind sail and tightly close the median opening from the side of the IV ventricle.

In the vast majority of cases, an undoubted connection between the development of the disease and a previous infection is established. Quite often there is a temperature reaction; changes in the leukocyte count of the blood characteristic of the inflammatory process are rarely observed. The composition of the cerebrospinal fluid depends on the period of the inflammatory process. In the subacute period, there is a moderately pronounced cytosis with a slightly increased or normal amount of protein. In the chronic course of the disease without exacerbation, the cerebrospinal or ventricular fluid has a composition that is normal or characteristic of hydrocephalus. Usually, in inflammatory diseases, both posterior cranial and cerebral symptoms are less pronounced than with tumors located in the posterior cranial fossa. Pronounced and persistent remissions and regression of the disease under the influence of rest and anti-inflammatory treatment are observed. Often there are cases when inflammatory diseases are very similar in clinical course to tumors of the posterior cranial fossa (see below) and it is difficult to make a differential diagnosis between them.

If conservative treatment is ineffective, the syndrome of increased intracranial pressure progresses and difficulty in cerebrospinal fluid circulation manifests itself, an operation to open the posterior cranial fossa is indicated. The detection of occlusion at the level of the median opening of the IV ventricle serves as an indication for dissection of the cerebellar vermis with opening of the cavity of the IV ventricle, which restores the outflow of fluid from the ventricular system into the basal cisterns and subarachnoid space. If during the operation it turns out that the difficulty in CSF circulation is associated with difficulty in outflow within the cavity of the IV ventricle or the cerebral aqueduct, Thorkildsen's operation is performed (see Hydrocephalus).

Usually, cerebellar ataxia is accompanied by chanted speech, intentional trembling, postural tremor of the head and trunk, and muscle hypotension. Diagnosis is carried out using MRI, CT, MSCT, MAG of the brain, dopplerography, analysis of cerebrospinal fluid; if necessary - genetic research. Treatment and prognosis depend on the causative disease that caused the development of cerebellar symptoms.

Cerebellar ataxia

Cerebellar ataxia is a symptom complex that includes specific disorders of static and dynamic human motility and is pathognomonic for any diseases of the cerebellum. The same type of motor coordination disorders occur both in congenital defects of the cerebellum and in a wide variety of pathological processes in the cerebellum: tumors, multiple sclerosis, strokes, inflammatory and degenerative changes, toxic or metabolic damage, external compression, etc. The degree of their severity varies significantly depending on on the location and size of the affected area of the cerebellum.

The nature of the disease can be judged by the symptoms associated with ataxia, as well as the features of the onset and course of pathological changes. The latter was the basis for the classification, which is used in their practice by many specialists in the field of neurology. According to it, cerebellar ataxia is distinguished with an acute onset, with a subacute onset (from 7 days to several weeks), chronically progressive (developing over several months or years) and episodic (paroxysmal).

Causes of cerebellar ataxia

The most common cause of acute cerebellar ataxia is an ischemic stroke caused by embolism or atherosclerotic occlusion of the cerebral arteries, which supply the cerebellar tissue as well. It is also possible hemorrhagic stroke, traumatic injury to the cerebellum as a result of a head injury or its compression by an intracerebral hematoma. Acute cerebellar ataxia can develop with multiple sclerosis, Guillain's syndrome, postinfectious cerebellitis and encephalitis, obstructive hydrocephalus, various acute intoxications and metabolic disorders.

Subacute cerebellar ataxia most often occurs as a symptom of an intracerebral tumor (astrocytoma, hemangioblastoma, medulloblastoma, ependymoma) located in the cerebellum, or meningioma of the cerebellopontine angle. Its cause may be normotensive hydrocephalus due to subarachnoid hemorrhage, meningitis, or brain surgery. Cerebellar ataxia with a subacute onset is possible with an overdose of anticonvulsants, vitamin deficiency, endocrine disorders (hyperparathyroidism, hypothyroidism). It can also act as a paraneoplastic syndrome in malignant tumor processes of extracerebral localization (for example, lung cancer, ovarian cancer, non-Hodgkin's lymphomas, etc.).

Chronically progressive cerebellar ataxia is often the result of alcoholism and other chronic intoxications (including substance abuse and polydrug addiction), slowly growing cerebellar tumors, genetically determined cerebral degenerative and atrophic processes with damage to the tissues of the cerebellum or its conduction pathways, and a severe form of Chiari anomaly. Among genetically determined progressive ataxias of the cerebellar type, Friedreich's ataxia, Nefridreich's spinocerebellar ataxia, Pierre-Marie's ataxia, Holmes's cerebellar atrophy, and olivopontocerebellar degeneration (OPCD) are the most well-known.

Cerebellar ataxia with a paroxysmal course can be hereditary and acquired. Among the causes of the latter, TIA, multiple sclerosis, intermittent obstruction of the cerebrospinal fluid, transient compression in the foramen magnum are indicated.

Symptoms of cerebellar ataxia

Ataxia of the cerebellar type is manifested by sweeping uncertain asynergic movements and a characteristic unsteady gait, during which the patient spreads his legs wide for greater stability. When you try to go along one line, there is a significant swing to the sides. Ataxic disorders increase with a sharp change in direction of movement or a rapid start of walking after getting up from a chair. Sweeping movements are the result of a violation of their proportionality (dysmetria). Both an involuntary stop of a motor act before its goal is achieved (hypometry), and an excessive range of motion (hypermetry) are possible. Dysdiadochokinesis is observed - the patient's inability to quickly perform opposite motor acts (for example, supination and pronation). Due to impaired coordination and dysmetria, a pathognomonic change in handwriting for cerebellar ataxia occurs: macrography, unevenness and sweeping.

Static ataxia is most evident when the patient tries to stand in the Romberg position. For the pathology of the cerebellar hemisphere, a deviation, and even a fall, towards the lesion is typical; with changes in its median structures (worm), a fall is possible in any direction or backward. Carrying out a finger-nose test reveals not only a miss, but also an intentional tremor accompanying ataxia - a trembling of the fingertip, which intensifies when it approaches the nose. Testing a patient in the Romberg position with open and closed eyes shows that visual control does not significantly affect the results of the tests. This feature of cerebellar ataxia helps to differentiate it from sensitive and vestibular ataxia, in which the lack of visual control leads to a significant aggravation of impaired coordination.

As a rule, cerebellar ataxia is accompanied by nystagmus and dysarthria. Speech has a specific "cerebellar" character: it loses its smoothness, slows down and becomes intermittent, stress goes to each syllable, which makes it look like a chant. Often, cerebellar-type ataxia is observed against the background of muscle hypotension and a decrease in deep reflexes. When causing tendon reflexes, pendulum movements of the limb are possible. In some cases, titubation occurs - a low-frequency postural tremor of the trunk and head.

Diagnosis of cerebellar ataxia

Since the pathology of the cerebellum can have a wide variety of etiologies, specialists from various fields are involved in its diagnosis: traumatologists, neurosurgeons, oncologists, geneticists, endocrinologists. A thorough examination of the neurological status by a neurologist makes it possible to determine not only the nature of the cerebellar ataxia, but also the approximate area of the lesion. So, the pathology in the cerebellar hemisphere is evidenced by hemiataxia, the one-sided nature of coordination disorders and a decrease in muscle tone; about the pathological process in the cerebellar vermis - the predominance of walking and balance disorders, their combination with cerebellar dysarthria and nystagmus.

In order to exclude vestibular disorders, a study of the vestibular analyzer is carried out: stabilography, vestibulometry, electronystagmography. If an infectious lesion of the brain is suspected, a blood test for sterility is done, and PCR studies are performed. Lumbar puncture with a study of the obtained cerebrospinal fluid allows you to identify signs of hemorrhage, intracranial hypertension, inflammatory or tumor processes.

The main methods for diagnosing diseases underlying the pathology of the cerebellum are neuroimaging methods: CT, MSCT and MRI of the brain. They allow to detect tumors of the cerebellum, post-traumatic hematomas, congenital anomalies and degenerative changes of the cerebellum, its prolapse into the foramen magnum and compression due to displacement of adjacent anatomical structures. In the diagnosis of ataxia of a vascular nature, MRA and Dopplerography of cerebral vessels are used.

Hereditary cerebellar ataxia is established by the results of DNA diagnostics and genetic analysis. The risk of having a child with a pathology in a family where cases of this disease have been noted can also be calculated.

Treatment of cerebellar ataxia

Fundamental is the treatment of the causative disease. If cerebellar ataxia has an infectious and inflammatory genesis, it is necessary to prescribe antibacterial or antiviral therapy. If the cause lies in vascular disorders, then measures are taken to normalize blood circulation or stop cerebral bleeding. For this purpose, in accordance with the indications, angioprotectors, thrombolytics, antiplatelet agents, vasodilators, anticoagulants are used. With ataxia of toxic origin, detoxification is performed: intensive infusion therapy in combination with the appointment of diuretics; in severe cases - hemosorption.

Hereditary ataxias do not yet have a radical treatment. Metabolic therapy is mainly carried out: vitamins B12, B6 and B1, ATP, meldonium, ginkgo biloba preparations, piracetam, etc. To improve metabolism in skeletal muscles, increase its tone and strength, patients are recommended massage.

Cerebellar and posterior fossa tumors often require surgical treatment. Removal of the tumor should be as radical as possible. When establishing the malignant nature of the tumor, an additional course of chemotherapy or radiotherapy is prescribed. With regard to cerebellar ataxia due to occlusion of the CSF pathways and hydrocephalus, shunt operations are used.

Forecast and prevention

The prognosis depends entirely on the cause of cerebellar ataxia. Acute and subacute ataxias caused by vascular disorders, intoxication, inflammatory processes, with timely elimination of the causative factor (vascular occlusion, toxic effects, infection) and adequate treatment, can completely regress or partially remain in the form of residual effects. Chronically progressive, hereditary ataxias are characterized by an increasing aggravation of symptoms, leading to the patient's disability. Ataxias associated with tumor processes have the most unfavorable prognosis.

Preventive in nature is the prevention of injuries, the development of vascular disorders (atherosclerosis, hypertension) and infection; compensation of endocrine and metabolic disorders; genetic counseling when planning a pregnancy; timely treatment of the pathology of the cerebrospinal fluid system, chronic cerebral ischemia, Chiari syndrome, processes of the posterior cranial fossa.

Cerebellar ataxia - treatment in Moscow

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Cerebellar injury in stroke

Cerebellar stroke, risks in the absence of treatment examination in pathology

Cerebellar stroke in medicine is the most dangerous lesion among other types of lesions. The cerebellum is a region in the brain that is responsible for proper coordination and balance of the body. A stroke in this part occurs when the blood flow in it is disturbed.

Sometimes this pathology can be confused with the stem form of a stroke, since both organs are located in the central nervous system in the neighborhood, but during a stem stroke, a bundle of nerves is damaged directly in the stem section.

In appearance, the cerebellum resembles a round-shaped process located on the back of the head close to the spine. His work is very important for the functioning of the whole organism:

Movement coordination.
Functioning of the optic nerve.
The work of the vestibular apparatus, balance, coordination and orientation in space.

What can cause an attack?

Pathology is formed under the condition that the supply of oxygen to the brain is interrupted or due to internal hemorrhage in the brain.

Cerebellar stroke is classified into two main types - hemorrhagic and ischemic. The ischemic type is much more common - in 75% of all cases of the disease, and is provoked by an unexpected deterioration in blood flow to the brain, which causes the formation of necrosis in the tissues. This process can be triggered by the following factors:

A large blood clot that forms in another part of the body interferes with blood flow in the vessels that are responsible for nourishing the brain.
A blood clot that has formed in an artery that carries blood towards the brain.
Breakthrough of a blood vessel, which is responsible for the flow of blood to a particular part of the brain.
Sudden fluctuations in blood pressure.

It is important! The causes of the hemorrhagic form of a stroke are ruptures in the blood vessels, provoking hemorrhages in the brain.

Symptoms indicating a stroke in the cerebellum

Symptoms of a cerebellar stroke develop unexpectedly and include the following manifestations:

Loss of coordination in the movements of the arms, legs and the whole body.
Difficulty in walking, imbalance of the body in space.
Abnormal disturbances of reflexes.
Trembling of limbs.
Nausea with vomiting.
Vertigo.
Intense headache.
Speech disorders and swallowing difficulties.
Disturbances in the sensations of pain and body temperature.
Hearing disorders.
Visual disturbances are rapid eye movements that can hardly be controlled by the person himself.
Problems with the work of the eyes, for example, a fallen eyelid.
Loss of consciousness.

If a person develops at least one of the listed signs, then it is better to immediately contact a specialist, since it is the brain tissues that are characterized by a rapid rate of death.

What is needed for effective diagnosis of the disease?

The consequences of a cerebellar stroke can be deplorable if a diagnostic examination of the patient's body is not carried out in time. Due to the fact that a cerebellar stroke becomes an unexpected unpleasant surprise, the doctor must make the correct diagnosis as soon as possible. Tests include:

Computed tomography is a type of x-ray examination that uses a computer to take pictures.
Angiography is a type of computed tomography that allows you to study the state of blood vessels in the neck and brain.
An MRI is a test that uses magnetic radiation to take pictures of the brain.
Tests to establish the norm of the functioning of the heart.
An ultrasound form of dopplerography - sound waves are used to determine the condition of the blood vessels.
Blood tests.
Kidney test.
A test to check the ability to swallow normally.

Organization of a suitable treatment process

If each of the listed symptoms of cerebellar stroke is subjected to abnormal influences, then doctors, in order to save the patient's life, prescribe him the organization of treatment in a hospital. Treatment of a cerebellar stroke involves the removal of embolism, blood clots, blood clots and scarring of blood vessels in the cerebellum. For this, appropriate medications are used to help thin the blood, control blood pressure, and treat deviations in fibrillation in the heart.

It is important! In almost half of all cases of the disease, the doctor prescribes a surgical operation. When it comes to ischemic stroke, doctors redirect blood flow to the blocked vessel, remove the clot, and then carry out the complex process of removing fat deposits in the carotid artery. In addition, stenting and angioplasty are often organized as operations that expand the lumen of the arteries.

With the development of a hemorrhagic form of stroke, surgery may involve trepanation of the skull and removal of part of it to reduce intracranial pressure. In addition, a special plug is placed in the aneurysm and severe bleeding is stopped.

The consequences of a cerebellar stroke are that, as a rule, after the development of a severe form of the disease, it is almost impossible to completely return to a person the functions he has lost. The main assistant in treatment is an optimistic attitude and concern for the patient. Thus, every year, the patient must go to a spa treatment, subject to the obligatory completion of a whole course of rehabilitation procedures - this is physiotherapy exercises, massages, reflexology, etc.

The prognosis of the disease already in the first minutes of an attack will depend on the location of the lesion, on the size and number of existing foci, as well as on the untimely started treatment process. With the formation of a large number of lacunar foci, the transformation of cerebellar infarction and the hemorrhagic form of stroke occurs.

Adverse factors in the manifestation of a stroke are the advanced age of the patient, a persistent rise in body temperature, that is, damage to the thermoregulatory center in the brain, cardiac arrhythmia, somatic diseases in their decompensation, depression of the patient's consciousness, pronounced cognitive impairment, advanced angina pectoris.

Cerebellar stroke

Cerebellar stroke, early recognition of which can save the patient's life.

Cerebellar infarction is the result of thrombosis or embolism of the cerebellar arteries, extending from the vertebral or basilar artery. It is manifested by hemiataxis and muscle hypotension on the side of the lesion, headache, dizziness, nystagmus, dysarthria and signs of concomitant lesion of the trunk - limited mobility of the eyeballs, weakness of facial muscles or impaired facial sensitivity on the side of the lesion, sometimes hemiparesis or hemihypesthesia on the opposite side.

As a result of rapidly growing edema, compression of the trunk with the development of coma and wedging of the tonsils of the cerebellum into the foramen magnum with a fatal outcome are possible, which can only be prevented by surgical intervention. It should be borne in mind that cerebellar hemiataxia may be a manifestation of a more favorably developing medulla oblongata infarction, which also causes Horner's syndrome (miosis, drooping of the upper eyelid), decreased sensitivity on the face, paramuscular muscles of the larynx and pharynx on the side of the lesion, and impaired pain and temperature sensitivity according to the hemitype on the opposite side (Wallenberg-Zakharchenko syndrome).

Hemorrhage in the cerebellum is more often caused by arterial hypertension and is manifested by a sudden intense headache, vomiting, dizziness, ataxia. Rigidity of the neck muscles, nystagmus, sometimes - restriction of the movement of the eyeballs in the direction of the lesion, inhibition of the corneal reflex and paresis of the mimic muscles on the side of the lesion appear. Oppression of consciousness increases rapidly with the development of coma. As a result of compression of the trunk, an increase in tone in the legs and pathological foot signs are added. In some cases, death can be prevented only by surgical intervention (hematoma evacuation).

Emergency care is limited to pain relief. For this, analgesics and non-steroidal anti-inflammatory drugs, sometimes corticosteroids, are administered parenterally. In the acute period, immobilization of the limb is necessary. In the future, therapeutic exercises and physiotherapy procedures are important to prevent the development of a “frozen” shoulder.

Acute incoordination of movements can be caused by damage to the cerebellum or its connections in the trunk (cerebellar ataxia), nerve fibers that carry deep sensitivity (sensitive ataxia), the vestibular system (vestibular ataxia), frontal lobes and related subcortical structures (frontal ataxia). It can also be a manifestation of hysteria.

Acute cerebellar ataxia is manifested by impaired balance, walking and coordination of movements in the limbs. Damage to the median structures of the cerebellum is accompanied by nystagmus, dysarthria according to [. ]

The differential diagnosis is carried out with cervical radiculopathy, which is not characterized by gross muscle atrophy, but is characterized by increased pain when moving the neck and straining, irradiation of pain along the spine. It is important to exclude diabetes mellitus, which can manifest as shoulder plexopathy, vasculitis. In a similar way, herpes zoster sometimes begins, but the appearance of a characteristic rash after a few days resolves diagnostic difficulties. A slightly different localization of pain is observed in the syndrome [. ]

Acute lumbalgia can be triggered by trauma, lifting an unbearable load, unprepared movement, prolonged stay in a non-physiological position, hypothermia. Most often, it occurs against the background of the current degenerative process in the spine (spinal osteochondrosis). The intervertebral disc gradually loses water, shrinks, loses its shock-absorbing function and becomes more sensitive to mechanical stress.

The cerebellum and coordination disorders

The cerebellum is a part of the brain that is responsible for the coordination of movements, as well as the ability to ensure the balance of the body and the regulation of muscle tone.

Basic functions and disorders of the cerebellum

The very structure of the cerebellum is similar to the structure of the cerebral hemispheres. The cerebellum has a cortex and a white substance underneath, which consists of fibers with cerebellar nuclei.

The cerebellum itself is closely connected with all parts of the brain, as well as with the spinal cord. The cerebellum is primarily responsible for the tone of the extensor muscles. When the function of the cerebellum is impaired, characteristic changes appear, which are commonly called "cerebellar syndrome". At this stage in the development of medicine, it has been revealed that the cerebellum is related to the impact on many important functions of the body.

With damage to the cerebellum, various disorders of motor activity can develop, vegetative disorders appear, and muscle tone is also disturbed. This is due to the close connection of the cerebellum with the brain stem. Because the cerebellum is the center of coordination of movements.

The main symptoms of damage to the cerebellum

When the cerebellum is damaged, the muscles are disrupted, it is difficult for the patient to keep the body in balance. To date, there are the main signs of cerebellar disorders of coordination of movements:

intention tremor
voluntary movements and slow speech
the smoothness of the movements of the arms and legs is lost
handwriting is changing
speech becomes scrambled, the placement of stress in words is more rhythmic than semantic

Cerebellar disorders of coordination of movements are expressed in gait disturbance and dizziness - ataxia. Difficulties may also arise when trying to get up from a lying position. The combination of simple movements and complex motor acts is disturbed, as the cerebellar system is affected. Cerebellar ataxia causes the patient to stagger, which is characterized by staggering from side to side. Also, when looking away to the extreme position, a rhythmic twitching of the eyeballs can be observed, this is how a violation of the movement of the oculomotor muscles is manifested.

There are different types of ataxia, but they are all similar in one main feature, namely impaired movement. The patient has statistical disturbances, even if he is pushed, he will fall without noticing that he is falling.

Cerebellar ataxia is observed in many diseases: hemorrhages of various origins, tumors, hereditary defects, poisoning.

Cerebellar congenital and acquired diseases

Diseases associated with the cerebellum are congenital and acquired. Marie's hereditary cerebellar ataxia is a congenital genetic disease of the dominant type. The disease begins its manifestation with impaired coordination of movements. This is due to hypoplasia of the cerebellum and its connections with the periphery. Often such a disease is accompanied by a gradual manifestation of a decrease in intelligence, memory is disturbed.

During treatment, the type of inheritance of this disease is taken into account, at what age the first symptoms, changes, deformations of the skeleton and feet appeared. There are also several more options for chronic atrophy of the cerebellar system.

Doctors usually prescribe conservative treatment for a patient with such a diagnosis. This treatment can significantly reduce the severity of symptoms. During treatment, you can significantly increase the nutrition of nerve cells, as well as improve blood circulation.

Traumatic brain injury can lead to acquired cerebellar disease when a traumatic hematoma occurs. Having established such a diagnosis, doctors perform a surgical operation to remove the hematoma. Also, damage to the cerebellum can cause malignant tumors, the most common of which are medulloblastomas, as well as sarcomas. A stroke-infarction of the cerebellum can also be the cause of hemorrhage, which occurs with atherosclerosis of blood vessels or a hypertensive crisis. With such diagnoses, surgical treatment of the cerebellum is usually prescribed.

Currently, transplantation of individual parts of the brain is not possible. This is due to ethical considerations, since the death of a person is ascertained by the fact of brain death, therefore, when the owner of the brain is still alive, he cannot be an organ donor.

Cerebellar stroke: causes and treatment

A cerebellar stroke occurs when the blood supply to an area of the brain is interrupted. Brain tissue that does not receive oxygen and nutrients from the blood quickly dies and this leads to the loss of some body functions. Therefore, a stroke is a dangerous condition for human life and requires emergency medical care.

There are two types of cerebellar stroke:

The most common form is ischemic cerebellar stroke, which occurs as a result of a sharp decrease in blood flow to the brain area. In turn, this condition can cause:

a clot that blocks the flow of blood to a blood vessel
a clot (thrombus) that has formed in an artery that carries blood to the brain
when a blood vessel ruptures and cerebral hemorrhage occurs

The consequences of a cerebellar stroke are: excessive sweating uneven breathing excessive pallor increased heart rate unstable pulse flushing of the face. To dissolve the clot that caused the ischemic stroke, emergency treatment is carried out. Also, medical attention is needed to stop bleeding during a hemorrhagic stroke.

During the treatment of ischemic cerebellar stroke, drugs are prescribed to help dissolve blood clots and prevent their formation, blood thinning drugs are prescribed to control blood pressure, to treat irregular heart rhythms. To treat ischemic cerebellar stroke, your doctor may perform surgery. It is strictly forbidden to self-medicate, because the wrong approach to the problem can cause a worsening of the condition.

Cerebellum

Pathology

Speech disorders in diseases of the cerebellum are observed in three forms: cerebellar bradilalia and scanned speech, bulbar, mixed. With bulbar disorders, expressed even in a mild degree, it is difficult to decide whether in this case, in addition to them, speech disorders are also of cerebellar origin. Only in rare cases, with mild symptoms of damage to the IX and X pairs of cranial nerves, the severity of scanned speech can suggest its cerebellar origin. In scanned speech, the stresses are not placed according to the meaning, but are separated by even intervals.