EpistemisSensory ataxia
Specialty: Neurology.
Why it occurs
- Subacute combined degeneration due to vitamin B12 deficiency
- Tabes dorsalis (neurosyphilis with posterior cord atrophy)
- Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)
- Severe thick fiber sensory polyneuropathy (diabetic, uremic or idiopathic)
- Paraneoplastic sensory ganglionopathy (associated with anti-Hu antibodies in small cell lung cancer)
- Toxicity due to excess vitamin B6 (pyridoxine)
Initial workup
Romberg maneuver (typically immediately positive); electromyogram and nerve conduction velocity (showing loss of sensory potentials with preserved or altered motor velocities depending on the cause); lumbar puncture to assess CSF proteins; dosage of vitamin B12, folates and lues serology.
red flags
Instability in walking that worsens drastically in the dark or when closing the eyes, progressing in a few days to the inability to remain standing and associating symmetrical motor weakness in the upper and lower limbs, suggesting sensory-motor Guillain-Barré syndrome.
Standard management
- Vitamin B12 (hydroxocobalamin 1000 mcg IM deep intramuscular) if deficiency is confirmed
- Intravenous penicillin G sodium in neurosyphilis
- Intravenous immunoglobulins or plasma exchange in autoimmune neuropathies
- Intensive visual-motor proprioceptive retraining physiotherapy.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Neurology
- Listed causes
- 6
- Treatment options
- 4