Balance disorder, also called ataxia, is a dysfunction of motor coordination. It manifests itself in a person’s loss of control over the position in space of his body, as well as in violation of the accuracy of movements. In this case, as a rule, the strength of the limbs themselves is completely preserved or decreases slightly. Experts distinguish between static ataxia, that is, imbalance in a standing position, and dynamic ataxia, which is a lack of coordination during movements.
A balance disorder occurs when the interaction between the vestibular apparatus and the central nervous system, namely the spinal cord, the cortex of some areas of the brain and the cerebellum, is disrupted.
Causes
There can be several causes of ataxia, for example, external factors that cause an unbearable load on the vestibular apparatus - riding on a carousel or sailing on a yacht. The less trained a person is, the stronger the imbalance will manifest itself when exposed to irritating factors.
Internal causes are pathologies in the functioning of the central nervous system associated with organic lesions of both the spinal cord and the brain and vestibular apparatus. These dysfunctions can occur due to intoxication (food, alcohol, medication), trauma or hereditary diseases.
Depending on the nature of the balance disorder, various causes of its occurrence can be identified. The most common is vestibular ataxia, in which a balance disorder occurs as a result of damage to this organ, which is responsible for the perception of a person’s position in space and the direction of movement. The vestibular apparatus is part of the inner ear, and its signals are generated by the movement of the sensory hairs located in it. Receptors in the inner ear transmit two types of signals to the brain - those associated with the position of the body and those associated with its acceleration during movement. Disorders of this complex system, leading to vestibular ataxia, are most often associated with diseases of the inner ear.
Vestibular balance disorder is associated with damage to the inner ear, often of an infectious nature. Untreated otitis media can lead to subsequent complications - permanent hearing loss and the risk of inflammation of the meninges (meningitis). Vestibular ataxia can also be associated with life-threatening diseases - malignant brain tumors, stroke and encephalitis.
Features of the ataxic gait
Due to imbalances, patients with pathological processes in the cerebellum try to increase the area of support, spread their legs widely, stagger and sway randomly when walking.
Movements of the upper and lower extremities lose synchrony. Instability persists in a standing position, regardless of the presence or absence of visual control. With unilateral damage to the cerebellum, one half of the body suffers, and falls on the affected side are possible. When cortical structures are involved, the clinical picture resembles that of cerebellar ataxia. Instability increases when turning, the patient often “falls” in the direction of the lesion, unsteadiness of gait correlates with the severity of the damage to the cortex. In people with damage to the ventrolateral thalamus, unsteadiness and instability occur on the opposite side, and there is a tendency to fall backward or to the healthy side.
Symptoms
The main signs characteristic of balance disorders are:
- dizziness;
- nausea and/or vomiting;
- noise in ears;
- lack of coordination;
- loss of body balance.
The listed symptoms are usually noted by patients independently. Some other symptoms can only be determined by a doctor - for example, one of them is horizontal nystagmus - uncontrolled eye movements.
Other symptoms that indicate the patient needs to consult a specialist:
- asymmetrical impairment of coordination of limb movements;
- falling when losing balance on only one side;
- speech and facial expression disorders.
These symptoms may be a sign of acute stroke or malignant lesions of the central nervous system and require immediate medical attention.
What can be done for an elderly person with unsteady gait
Since unsteady gait increases the risk of falls, it is important to secure the elderly person's home:
- Remove all items from walkways (shoes, furnishings, extension cords, etc.).
- The corridors should be well lit (especially the path to the bathroom, toilet and kitchen).
- Place non-slip mats on the floor of the bathtub as well as at the exit of the bathtub.
- Buy comfortable house shoes with non-slip soles.
- You can keep a flashlight by your bed and use it if you need to get up at night.
According to doctors' recommendations, an elderly person needs:
- wear leg braces and orthoses;
- use a cane or walker for additional support and balance.
Diagnostics
If dizziness and loss of balance bother you constantly, and not just when exposed to factors that irritate the vestibular apparatus, you should consult a doctor. The primary diagnosis is carried out by a therapist; depending on the identified symptoms, he prescribes further examinations and refers to a specialist - an otolaryngologist, neurologist or oncologist.
To accurately determine the causes of balance dysfunction, a general and biochemical study of the patient’s blood is prescribed to exclude the presence of an infectious lesion. At the same time, depending on the symptoms, radiography of the skull bones, electroencephalography, MRI of the brain, electromyography of the limbs and Doppler sonography of the brain are performed.
Which doctor treats balance disorders?
Balance disorders are treated by a neurologist. At the Kuntsevo Center, experienced specialists offer their services to patients who use new methods to eliminate ailments. To accurately determine the cause of the disease, a visual examination is carried out and the accompanying symptoms are clarified. The root causes of balance disorders can be both pathologies in the cervical spine and diseases of the brain.
To diagnose the disease, patients are prescribed electromyography, encephalography, MRI, and clinical and biochemical blood tests. The clinic approaches the treatment process comprehensively. The patient is recommended to undergo a general examination of the body and undergo a tomography of the spine. When concomitant ailments are identified, highly specialized specialists are involved in the work.
Treatment
Treatment of balance disorders is carried out depending on the etiology of the disease that led to symptoms of incoordination. Acute diseases such as stroke and encephalitis are treated only in a hospital setting. For a mild form of the disease that occurs when traveling on public transport, the doctor may recommend medications prescribed for seasickness.
For vestibular ataxia associated with inflammation of the inner ear, it is necessary to first eliminate the source of infection; for this purpose, antimicrobial drugs are used. In parallel, concomitant treatment is prescribed - non-steroidal (Otinum, Otipax) or corticosteroid (Sofradex, Polidexa) drugs to relieve swelling, immunostimulating agents (Laferobion, Vitaferon, Lyophilisate) and vitamin preparations.
For balance disorders that are not infectious in nature, a complex of drugs is prescribed:
- synthetic histamine analogue;
- nootropic drugs (Nootropil, Piracetam, Phenibut);
- antihypoxants and drugs that improve cerebral circulation (Actovegin, Vinpocetine, Cavinton);
- muscle relaxants, for example, Mydocalm;
- anticonvulsants;
- vitamin complexes.
In addition to drug therapy, physiotherapy is also used. It includes physical therapy, massage and electrical stimulation of the muscles of the limbs. These methods improve muscle tone and stimulate overall muscle function.
The reception is conducted by specialists
Why does a shaky gait occur?
Hereditary diseases
Atactic gait is a constant or possible symptom of some hereditary pathologies:
- Ataxia of Pierre-Marie.
Unsteady gait and other manifestations of ataxia occupy a leading place in the clinical picture of the disease, complemented by oculomotor and visual disturbances, and mental disorders of a neurotic level. - Friedreich's ataxia.
A progressive degenerative disease that manifests itself in the third decade of life. The symptom occurs at the initial stage, and is subsequently supplemented by dysarthria, paresis and muscle atrophy. - Spinocerebellar ataxia.
A group of hereditary pathologies in which an unsteady gait and clumsiness of movements are detected in combination with parkinsonism and optic nerve atrophy. - Olivopontocerebellar degenerations.
Ataxic gait is considered as a basic sign of pathology, complemented by hyperkinesis, secondary parkinsonism, cognitive and mental disorders. - Wilson-Konovalov disease.
The sign is optional, detected in a rare extrapyramidal-cortical form, combined with severe intellectual deficit, pyramidal disorders, and epileptic seizures.
Circulatory disorders
The cause of an ataxic gait may be ischemia or hemorrhage. Possible provoking factors are cerebral atherosclerosis, arteriovenous malformations, and other vascular disorders. In most cases, the pathology develops acutely, and the clinical picture of a stroke is revealed. Less commonly, for example, with Kimerli’s anomaly, cerebellar symptoms progress gradually.
The involvement of cerebellar structures is indicated by a decrease in muscle tone on the affected side, macrography, and extended scanned speech. When cortical structures are damaged, characteristic mental changes and olfactory disorders are detected. The grasping reflex is determined. There is no hypotonia of the muscles of the affected half of the body.
Ataxia
Tumors
Among oncological diseases, the most significant role in the occurrence of ataxic gait is played by cerebellar tumors. The clinical picture is variable and includes ataxia, general cerebral symptoms, and signs of brainstem compression. The listed groups of symptoms can occur either simultaneously or sequentially. A shaky gait is combined with dizziness, cephalalgia, and vomiting of central origin. General cerebral symptoms are especially pronounced when the outflow of cerebrospinal fluid is obstructed.
Cerebellar disorders tend to increase and spread. When the tumor is located in one hemisphere of the cerebellum, difficulties in maintaining balance are observed on one side; as the neoplasia grows, bilateral coordination disorders begin to predominate. Involvement of the trunk is indicated by strabismus, neuritis of the trigeminal and facial nerves, hearing loss, and oculomotor disorders.
With neoplasms of the cerebral hemispheres, dizziness occurs later than with neoplasia of the cerebellum. During an ophthalmological examination, congestive optic discs are detected on both sides. There is a high prevalence of mental pathologies - from mnestic and emotional disorders to delusions and hallucinations.
Traumatic injuries
Unsteady gait becomes a consequence of intracranial hematomas of the corresponding localization, compression of the frontal lobes by subdural and epidural hematomas. In acute hematomas, symptoms develop within a few hours or days, in chronic hematomas - over weeks, months or years. Possible headaches, dizziness, vomiting not associated with food intake, epileptic seizures, “frontal” mental disorders with elevated mood, ridiculous behavior and decreased criticism.
Brain abscesses
The clinical picture of the abscess is consistent with other space-occupying lesions of the cortex or cerebellum; there are no specific symptoms. The infectious nature of the process is indicated by the presence of injuries and operations on brain structures, purulent-inflammatory lesions of the ENT organs, an acute onset with signs of intoxication, the rapid formation of an unsteady gait with the subsequent stabilization of neurological disorders after the formation of a capsule that prevents the spread of pus to neighboring structures.
Encephalitis
Balance disorders with the development of an ataxic gait are more typical for secondary encephalitis: influenza, measles, post-vaccination. The risk of developing ataxia increases with severe encephalitis with severe neurological disorders. In some cases, an unsteady gait is detected in patients who have suffered an encephalitic form of tick-borne encephalitis.
Multiple sclerosis
An unsteady gait can be observed already at the onset of the disease, but is not detected in all patients, which is explained by the polymorphism of symptoms, especially in the initial stages. Subsequently, cerebellar pyramidal and sensory disorders form a typical clinical picture of multiple sclerosis. Asynergy of movements, ataxic gait and other symptoms of cerebellar damage are combined with intention tremor and hyperkinesis. Paresis, optic neuritis, and ophthalmoplegia are often detected.
Other reasons
Other pathologies associated with ataxic gait include:
- Multiple system atrophy.
Unsteady gait, intention tremor and other cerebellar disorders are detected in a third of patients, in 10% of cases they are combined with parkinsonism. - Intoxication.
Chronic cerebellar degeneration can be caused by alcoholism, drug addiction and substance abuse. Acute and subacute disorders occur with an overdose of anticonvulsants. - Endocrine diseases
. Cerebellar disorders are subacute in nature, with an ataxic gait developing over several weeks or months. - Paraneoplastic syndrome.
It is observed in malignant neoplasms of extracerebral localization: ovarian cancer, lung cancer, non-Hodgkin's lymphomas. - Occlusive hydrocephalus.
Polyetiological condition with acute or subacute onset. Unsteady gait, intense cephalgia, and frequent nosebleeds are detected.