Vestibulo-atactic syndrome.

Vestibulo-ataxic syndrome is not a separate disease. Doctors make this diagnosis when a patient has a certain set of certain symptoms. Individually, these symptoms can indicate various diseases, and in combination they allow diagnosing a pathology caused by various disorders in the vascular system of the body.

Causes of vestibulo-atactic syndrome

What can cause vestibulo-ataxic syndrome? It is impossible to answer this question unequivocally, since the appearance of this pathology can be preceded by various events and diseases:

• Cerebellar dysfunction.
• Chronic circulatory failure.
• Various pathologies of the brain.

And also:

• Cerebral palsy (CP).
• Dropsy of the brain (hydrocephalus).
• Death (atrophy) of brain cells.
• Hypertensive disorders.
• Atherosclerosis.
• Malignant or benign brain tumors.

Symptoms of ataxia often accompany multiple sclerosis, a disease that is virtually untreatable and affects the brain and spinal cord.

In 25% of cases, vestibulo-ataxic syndrome is observed in patients after removal of an extracerebral tumor.

Risk factors

Risk factors include:

• Birth injuries in newborns.
• Various skull injuries.
• Complicated infectious diseases.
• Acute or chronic drug intoxication.
• Increased background radiation.
• Lack of vitamins and microelements in the body.
• Bad habits.
• Heredity.

As you can see, vestibulo-ataxic syndrome accompanies many diseases, so you should not underestimate it. The symptoms of this pathology are only a consequence of more serious diseases associated with dysfunction of the brain, which in advanced forms can lead to disability and even death.

In some cases, the appearance of signs of ataxia, in other words, a violation of the motor functions of the body, may indicate age-related disorders in the functioning of the musculoskeletal and vestibular systems.

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Pathogenesis

In the practice of a neurologist, vestibulo-ataxic syndrome is most often observed in patients with cerebral ischemia, when, due to impaired blood flow, the brain does not receive an adequate amount of oxygen.

The pathogenesis of this pathology includes insufficient blood flow in the vertebrobasilar system, which combines the vertebral and central (basal) arteries of the brain, impaired blood circulation in the brain stem structures, as a result of which their energy supply and connections with other parts of the central nervous system (CNS) are disrupted.

The brain stem formations are sensitive to hypoxia (oxygen starvation of systems and organs), which determines the high prevalence of vestibular-ataxic syndrome and the variety of forms and manifestations of this pathology in cerebral ischemia.

The clinical picture may vary depending on the cause of the disease, age and condition of the patient. For example, in older patients, a disorder of the central part of the vestibular analyzer is often combined with damage to its peripheral part, which forms a unique picture of the pathological disorder.

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Symptoms of vestibulo-atactic syndrome

This pathology is a combination of motor and vestibular disorders due to disruption of general and cerebral circulation. It is quite common, many have noticed its symptoms in themselves without attaching much importance to them. If a person starts feeling dizzy while walking, is thrown from side to side, and has impaired coordination of movements, this is already a reason to immediately consult a doctor.

We have figured out what vestibulo-ataxic syndrome is and what its causes are. What signs and complaints of patients allow a neurologist to diagnose ataxia?

Ischemic disorders in the functioning of the brain are dangerous because they can be simply overlooked in the early stages, since the first symptoms that appear can correspond to various health disorders and the patient's condition. A person can simply ignore individual cases of malaise. This complicates the timely diagnosis and treatment of diseases that are companions of vestibulo-ataxic syndrome.

The first signs of the initial stage of the disease are:

• Frequent dizziness, especially when walking.
• Flickering and spots before the eyes.
• Nausea and vomiting.
• Headache.

At later stages, movement disorders appear:

• Loss of balance.
• Throwing from side to side.
• Falls.
• Involuntary twitching of the eyelid

In addition, many patients complain of:

• Deterioration in the quantity and quality of sleep.
• Chronic fatigue, loss of strength.
• Noise or ringing in the ears.
• Unpleasant sensations when maintaining the same body position for a long time.

Cephalgic syndrome

Cephalgic vestibulo-ataxic syndrome, in other words headache, is a human health disorder that not only brings discomfort to our lives, but can also be a warning signal of more serious disorders of the body's functioning, such as diseases of the brain and central nervous system. Of particular concern to doctors is the increasingly widespread prevalence of this condition, both among adults and among children and adolescents.

Cephalgia is perhaps the most common symptom and sign of many pathological conditions of the brain. Its occurrence is associated with oncological, inflammatory, infectious diseases, metabolic disorders, vascular, neuralgic diseases. Even the presence of bad habits and disruption of the daily routine can cause acute cephalgic syndrome.

The variety of causes of this disorder makes it very difficult to diagnose cephalgia as a symptom of a certain disease. After all, eliminating headaches should be one of the stages of treating the disease that caused it, and not a separate process.

Cephalgic syndrome can be caused by both ordinary nervous overstrain, fatigue, and be one of the main symptoms of vestibulo-ataxic syndrome associated with serious diseases of the brain. Therefore, it is necessary to take a responsible attitude to any of its manifestations in order to protect yourself from the development of severe forms of the disease with irreversible neuropsychic processes.

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Discirculatory encephalopathy with vestibulo-ataxic syndrome

Vestibulo-ataxic syndrome may be a harbinger of such a serious disease as cerebrovascular insufficiency.

The brain is the main organ of the central nervous system, responsible for the vital functions of the body and controlling its work. It consists of nerve cells that perform different functions and are responsible for certain actions, such as speech, thinking, movement, memory, etc.

For normal brain function, oxygen is necessary, which helps to break down glucose and produce the energy necessary for work. If there is insufficient oxygen supplied by the bloodstream and the toxic effect of certain substances on brain cells, nerve cells begin to die, causing certain disturbances in the functioning of the brain, depending on which part of the brain is affected.

Such disorders in the functioning of the brain are called encephalopathy of the brain. Its most common type is discirculatory encephalopathy with vestibulo-ataxic syndrome, which in the last 3 stages of the disease can lead to severe disorders of memory, intelligence and thinking in general (dementia).

Forms

Depending on the stage of the disease and the degree of its progression, there are 3 types of ataxic pathology: mild, moderate and severe ataxia. Each stage is characterized by a certain set of symptoms indicating how serious the situation is. Knowing this information helps to diagnose vestibular-ataxic disorder at any stage and to begin further diagnostics and treatment of concomitant pathological conditions in a timely manner.

Mild vestibulo-ataxic syndrome does not have pronounced specific symptoms. Patients notice slight changes in gait and coordination of movements.

With a moderate degree of severity of vestibulo-ataxic syndrome, disturbances in motor functions and coordination of movements are already more noticeable. Staggering gait, tossing from side to side, pronounced problems with coordination - these are all symptoms of moderate ataxia. To them are added problems with the vestibular apparatus: headache, dizziness, nausea, nervous reactions of the eye and its surroundings.

Severe vestibulo-ataxic syndrome is the most severe stage of the disease. At this stage, it is difficult for a person to move or maintain a certain position, the gait completely resembles the movement of a person in a state of severe alcohol intoxication, which causes the need to constantly carry a certificate confirming the diagnosis in case of detention by police officers who take such patients for drunks or drug addicts.

As a rule, at this stage of the disease, patients are assigned disability. But the possibility of assigning disability depends not so much on the presence of a particular stage of the disease, but on the persistence and severity of its symptoms.

As we can see, the more advanced the disease, the more serious its symptoms are. Vestibulo-ataxic syndrome, if not given enough attention, can have various complications and unpleasant (sometimes tragic) consequences. These include injuries from falling, spasms of the cerebral vessels, development of cephalgic syndrome with constant headache, paralysis, stroke, etc.

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Diagnostics of vestibulo-atactic syndrome

Diagnosis of vestibular-ataxic syndrome includes multiple examinations of the body, aimed not only at diagnosing this vestibular disorder, but also at identifying the possible cause of the syndrome itself - concomitant diseases.

For an accurate and correct diagnosis, differential diagnostics is used, which, in addition to collecting anamnesis, neurological examination of the patient taking into account his complaints and testing, includes laboratory and instrumental diagnostic methods.

Laboratory tests for suspected vestibular ataxia include the following:

• Blood test for biochemistry
• General urine analysis
• Cerebrospinal fluid biopsy

A clearer picture of the disease is provided by instrumental diagnostics, consisting of:

• Magnetic resonance imaging and computed tomography, which can detect tumors in the brain
• Electroencephalography to determine the bioelectrical activity of the brain
• Echoencephalography, which allows determining the state of the brain's cerebrospinal fluid system, which is responsible for a person's well-being, as well as detecting formations such as a hematoma, tumor or brain abscess.
• Rheoencephalography, which helps to assess the condition of blood vessels and blood circulation in them.
• X-rays of the skull and spine.

Additional information about the severity of the disease can be obtained by using rapid tests for diagnostic purposes:

• Romberg test for assessing cerebellar function and static ataxia.

The patient takes the required position: legs together, arms forward, fingers spread. He is asked to close his eyes. If a person begins to stagger, loses balance, this indicates certain disorders in the functioning of the cerebellum. Deviation of the fingers on the hands indicates which hemisphere of the brain is affected.

• Finger-nose test

The patient is asked to close his eyes and alternately reach the tip of his nose with the index fingers of both hands. The presence of vestibulo-ataxic syndrome is determined by tremors in the hands, inaccurate hit.

• Knee-heel test

From the supine position, the person is asked to lift one leg and touch it to the knee of the other leg, then lower the leg, running the heel along the shin of the other leg. Damage to the cerebellum, which is responsible for coordination and balance, causes certain difficulties in performing this task.

The diagnosis is made by a specialist doctor or a panel of doctors based on the prescribed tests.

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Treatment of vestibulo-atactic syndrome

Treatment of vestibulo-ataxic syndrome is based on a diagnostic examination. It is not only medications and physiotherapy. To achieve good results in the treatment of this disorder, patients are advised to reconsider their attitude to health by leading a healthy lifestyle, giving up bad habits and eating a balanced diet.

Since one of the main causes of vestibular disorders is high blood pressure, the first stage of therapy consists of reducing blood cholesterol levels (statins - Atoris, Rosuvastatin) and blood pressure (antihypertensive drugs - Captopril, Enalapril, etc.)

Priority in the treatment of vestibulo-ataxic syndrome is given to the following drugs:

Actovegin

Available in the following forms:

• Injection solution – ampoules of 2 ml, 5 ml and 10 ml.
• Solution for infusion – 250 mg bottle.
• Tablets – 200 mg.

Actovegin is recommended to be taken orally, 1-2 tablets three times a day before meals, without chewing the tablet, with a small amount of water.

The initial recommended dosage for injections is 10-20 ml and depends on the severity of the disease, then the dosage should be reduced to 5 ml once a day or several times a week.

For a dropper, use 250 ml of infusion solution at a rate of 2-3 ml per minute once a day (10-20 droppers per course).

Precautions: It is not recommended to use the drug during pregnancy and breastfeeding.

When administered by injection, there is a risk of developing Quincke's angioedema.

Side effects: Hives in the form of itching and reddening of the skin, hyperhidrosis (increased sweating), slight chills or fever.

Mildronate

Available in the following forms:

• Injection solution - 5 ml ampoules.
• Capsules (tablets) – 250 mg, 500 mg.

For chronic disease, 0.5-1 g (1-2 tablets of 500 mg or 2-4 tablets of 250 mg) per day for 4-6 weeks.

In the acute phase – intravenously 0.5 g once a day for 10 days.

It is not recommended to use during pregnancy and nursing mothers. It is used with caution in pathological conditions of the liver and kidneys. It is contraindicated for children under 18 years of age, patients with increased intracranial hypertension, intracranial neoplasms and venous outflow disorders.

It should be taken with caution in combination with other medications, as it tends to enhance the effects of many of them.

Side effects: Often does not cause life-threatening side effects for the patient.

Sometimes there are allergic reactions, changes in blood pressure, agitation, increased heart rate, dyspeptic symptoms: heartburn, belching, diarrhea, etc.

Mexidol

Available in the following forms:

• Injection solution - 2 ml, 5 ml
• Tablets - 125 mg

Mexidol is taken orally, one or two tablets three times a day for 2-6 weeks.

The drug is administered by injection starting with a dose of 0.1 g 1-3 times a day, gradually increasing the dosage. Maximum – 0.8 g.

Precautions: The drug is contraindicated in case of allergy to vitamin B6, in childhood, during pregnancy, breastfeeding, as well as in case of severe functional disorders, organic liver and kidney damage.

In case of overdose it causes drowsiness and affects the reaction speed.

Side effects: Allergic reactions of varying intensity, skin reactions in the form of urticaria, itching, skin hyperemia, nausea, sometimes vomiting, a feeling of dry mouth are possible.

Overall, the drug is well tolerated by most patients.

Additionally, the following may be assigned:

Cavinton

• Tablets – 5 mg, 10 mg.

For this pathology, Cavinton is taken orally at 5 mg (1 tablet of 5 mg or ½ tablet of 10 mg) 2-3 times a day for 1-8 weeks.

It is contraindicated during pregnancy and breastfeeding. It is not prescribed in case of hypersensitivity to the components, acute phase of cerebral hemorrhage, severe degree of coronary heart disease (unstable angina) and conduction disturbances of the heart rhythm (arrhythmia).

Cavinton may affect the speed of response.

Side effects: Tachycardia, interruptions in cardiac activity, slight pallor of the skin, signs of allergy (itching, hyperemia (redness) of the skin), sleep disturbances (insomnia, night terrors), vertigo (dizziness), low-intensity headache, migraine attacks, hyperhidrosis, fatigue and weakness, nausea, sometimes vomiting, heartburn, dry mouth.

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Trental

Release forms:

• Injection solution – 5 ml ampoule.
• Tablets – 100 mg.

Directions for use:

• Droppers – 100-600 mg once or twice a day.
• Intravenous injections of 100 mg once or twice daily. The patient should be in a horizontal position.
• Take two to four tablets orally 2-3 times a day after meals, without chewing, with water.

Precautions: Trental is contraindicated during pregnancy and breastfeeding, gastric ulcer and duodenal ulcer, tendency to gastrointestinal bleeding, strokes of various origins, retinal hemorrhages.

Use with caution in severe forms of cardiovascular pathological conditions, tendency to sharp jumps in blood pressure, stomach ulcers, in the postoperative period.

Side effects: Usually well tolerated by patients, but occasionally there are such disorders: nausea, sometimes vomiting, bowel movement disorders (constipation or diarrhea), decreased blood pressure, palpitations, headache, migraine attacks, vertigo, irritability, emotional instability, sleep quality disorders (insomnia, nightmares), skin allergic reactions in the form of hyperemia and skin itching, Quincke's angioedema.

In complex therapy, the use of drugs from the group: vitamins and microelements, for example from the Vitrum series, is indicated.

Physiotherapy usually complements medication and includes therapeutic baths, massage and therapeutic exercises, oxygen therapy and other physical procedures as prescribed by the doctor. Acupuncture and hypnosis are sometimes used.

Traditional treatment of vestibulo-ataxic syndrome is carried out in combination with medication. Let's consider several recipes that will help relieve the main symptoms of the disease:

• To thin the blood and increase blood flow in the brain vessels, we use garlic.

Peel large heads of garlic, grind them in a meat grinder and leave in a dark, cool place for 3 days. Strain and mix 1:1:1 with honey and lemon juice. Take 1 tbsp before bed.

• At high pressure.

Corn silk (40 g) and lemon balm (20 g) are mixed with lemon juice and poured with 1 liter of boiling water. Infuse for 1 hour.

Strain and take half a glass 3 times a day half an hour after meals.

• To improve cerebral circulation.

Mix ½ kg cranberries, 150 g finely grated horseradish and 350 g honey thoroughly. Take 2 teaspoons daily after meals with tea or water.

• For cleaning blood vessels.

Pour 1 tbsp of juniper berries into 200 g of boiled water at room temperature. Leave to infuse for 8-10 hours. Take 1 tbsp 3-4 times a day. The course is 1.5-2 months.

Herbal treatment gives good results in the treatment of vestibulo-ataxic syndrome. Traditional medicine doctors offer several recipes:

• For dizziness and tinnitus.

Mix equal parts of thyme, motherwort, mint and borage flowers. № tbsp. Pour 450 g of boiling water over the mixture and leave for 2 hours. Strain thoroughly and take ½ cup 2 times a day after meals.

• For dizziness and headaches.

Pour 1 tbsp of dried primrose flowers with 1 tbsp of boiling water and leave for 30 minutes. Drink warm instead of tea.

• For headaches.

Pour 2-3 teaspoons of mint herb with a glass of boiling water. Leave for half an hour. Take in equal parts throughout the day, after straining.

In case of intolerance to synthetic drugs and various contraindications, homeopathy comes to the rescue. Of the homeopathic preparations, the following have shown good effectiveness:

Golden iodine

Dosage: 5 granules twice daily under the tongue 20 minutes before meals or one hour after meals for 2 months.

Precautions: Golden iodine is contraindicated in case of individual hypersensitivity to the components of the drug, pregnancy and breastfeeding. It is not recommended for use in childhood.

Side effects: Rarely, allergic reactions may occur: skin rash, itching.

Hypertensin

Take the drug five granules in the morning and evening half an hour before meals.

For acute conditions, three to five granules every 10-15 minutes.

Precautions: Contraindicated in case of hypersensitivity to the drug.

No side effects were found.

Venartin

The usual dosage is 7 granules 2-3 times a day under the tongue half an hour before meals.

The course of treatment is 1 month with repetition after 1-2 weeks.

Precautions: Do not combine with food, various teas, including herbal teas, nicotine, alcohol, camphor-menthol preparations and essential oil inhalations.

No side effects were identified.

Tanakan is a preparation based on the ginkgo biloba plant.

Dosage:

• Take one tablet three times a day during meals with water.
• Solution one dose three times a day during meals, previously dissolved in 0.5 cups of water.

The course duration is 1-3 months.

Precautions: Contraindicated for children under 18 years of age, use only for individual indications.

Do not use during pregnancy and breastfeeding, during exacerbation of gastric ulcer and duodenal ulcer, erosive gastritis, lactose intolerance, acute myocardial infarction, unstable angina and low blood clotting rates.

Do not use simultaneously with Warfarin and Aspirin.

Side effects: Allergic reactions, decreased blood clotting, gastrointestinal bleeding, eczema, digestive disorders (dyspepsia), diarrhea, constipation, nausea, sometimes vomiting, headaches and migraine attacks, tinnitus, vertigo are possible.

If the proposed methods do not bring the desired results, surgical treatment is prescribed. Vertebral artery surgery is performed by top-category doctors, as it is a complex surgical intervention. However, it is minimally invasive and brings good results.

Prevention

The first principle of preventing vestibulo-ataxic syndrome is to prevent the development and progression of cerebral ischemia, the main cause of this syndrome. If signs of motor and vestibular disorders appear, you should immediately consult a doctor. Do not ignore recurring headaches, which can be the cause of serious diseases.

But the most important thing is a healthy, active lifestyle, giving up bad habits, and fighting obesity. It is also necessary to limit sun exposure, avoid stressful situations (especially for patients at risk), and follow doctors' orders if you have certain diseases.

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Forecast

With timely treatment and appropriate treatment, the prognosis for vestibular-ataxic syndrome is generally favorable. Difficulties in treatment may arise only in older patients due to irreversible changes in the body and in patients with tumors in the brain that require surgical intervention.

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