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sudden ataxia
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sudden ataxia

In February 2008 I had a severe sinus infection which required 30 days of anitbiotics.  I couldn't hear anything in the left ear and had very poor hearing in the right ear.  Left ear actually "leaked" and I was left with hole in eardrum.  Had eardrum repaired with a graft from behind my ear.  No vertigo, pain or infections since ear healed.  

Had meniscus surgery in May - by June I had so much pain in bursa of hips and both knees I went back to ortho man.
Was given a cortisone shot in each knee and while still at office I couldn't stand without holding on.  Legs very heavy and weak.  MRI showed spinal stenosis L5 and neurologist said it shouldn't be causing ataxia which steadily developed.  I went for second opinion to another neurologist and miserably failed gait tests.  Had MRI 8/15 to rule out lesions of basal ganglia and cerebellar region plus blood work specifically to rule out Lyme, B12 and other neuro problems.  Tests results all fine.  Will go 9/16 for second EMG.

I am thrilled not to have a brain tumor but the ataxia is severe.  I walk with a cane, can not go distance withiout extra assistance and have developed a "hopping" gait within last two weeks.  I have no pain at all - just get exhausted by mid-day.

Any thoughts or ideas?  Neuro doctor is doing great by me - taking it a step at a time to rule out most obvious problems.

Thank you very much for your time.

Franim
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Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to obtain a history and examine you, I can not provide you with a diagnosis. However, I will try to provide you with some general information on ataxia. It is good that you feel comfortable with your neurologist's plan, and that you are scheduled for an EMG. Spinal stenosis can sometimes cause leg weakness and gait problems, however, without being able to examine you I can not comment further on this.

Ataxia is a symptom of 100s of neurologic diseases. Cerebelllar ataxia is one type of ataxia occuring due to a problem in the cerebellum, one of the structures in the brain involved in coordination (among other things). There are several causes of cerebellar ataxia and whether or not the ataxia can be treated depends on the cause. Below, a few types of ataxias will be discussed but this list is by no means comprehensive.

In general, ataxias could be divided into a few groups (1) those with a known external cause such as alcoholism or other medications or drugs (2) those that occur following infection (3) those that are neurodegenerative, due to loss of cerebellar cells because of a primary abnormality in cerebellar cells as opposed to an external cause such as infection (4) due to an inborn error metabolism and/or a genetic defect that disrupts metabolism in cerebellar cells (5) those that occur in the setting of cancer, known as "paraneoplastic ataxias", and (6) others

Regarding the cerebellar ataxias due to an external cause, in some cases symptoms resolve (sometimes physical therapy is needed). In some patients, cerebellar ataxia occurs following an infection that affects the nervous system, in which case it often resolves. Chronic alcoholism can cause cerebellar ataxia; stopping alcohol intake can improve the ataxia but if it is severe, some permanent symptoms may remain. In patients with cerebellar stroke, with intensive physical and occupational therapy over weeks to months, symptoms may become minimal and may even resolve completely. In patients with cerebellar ataxia due to a tumor in the cerebellum, removal of the tumor often improves ataxia significantly, though some remaining symptoms may persist due to removal of normal cerebellar tissue following surgery. And so on.

For the inborn errors of metabolism, some treatable examples include betalipoproteinemia, adrenomyeloneuropathy, cerebrotendinous xanthomatosis, familial vitamin E deficiency, maple syrup urine disease, pyruvate dehydrogenase deficiency, Refsum disease, and Wilson disease. Certain features in your history and physical examination will suggest these disorders, because they are most often associated with other abnormalities. Many of these disorders begin in childhood or adolescence/young adult-hood. Management typically relies on dietary modification, vitamin/cofactor supplementation, or drugs to reduce the load of the accumulating toxic metabolite, or removal of abnormal proteins from the blood by a procedure called plasmapharesis.

In cerebellar ataxia due to cancer, what is called a paraneoplastic process and can be diagnosed with blood tests, with removal of the tumor and treatment with an intravenous medication or immunosuppresants, cerebellar function improves.

Other types of cerebellar ataxias that are genetic such as the large group of genetic disorders called "spino-cerebellar ataxias", Ataxia-telangiectasia, Friedreich ataxia, and other mitochondrial disorders are being studied, certain modifications may be helpful but there is not a cure. These have specific features that suggest one type versus another and genetic testing is available for some of them.

Thank you for using the forum, I hope you find this information useful, good luck.
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