What Is Acute Cerebellar Ataxia?

Acute cerebellar ataxia (ACA) is a disorder that causes a sudden loss of control of movement due to disease or injury to the cerebellum. The cerebellum is the part of the brain that controls muscle movement and gait (a person's pattern of walking). The term ataxia refers to uncoordinated and abnormal movements of the body.

The cerebellum is a major part of the brain and plays a vital role in controlling muscle movement and balance. The cerebellum is responsible for maintaining posture, coordinating gait, and controlling muscle tone. Although the cerebellum controls voluntary muscle movement, it does not initiate muscle contraction.

When the cerebellum becomes damaged, you can lose the ability to maintain your posture and control of fine movements, such as picking up a fork. Your motor learning can also be affected, making it difficult to learn new physical skills like running or throwing a ball.

Types of Acute Cerebellar Ataxia

Acute cerebellar ataxia is characterized by the way it affects the cerebellum and by the age of onset. ACA most commonly affects children and begins abruptly. Recovery usually takes a few weeks, depending on the cause.

In adults, acute cerebellar ataxia is less common but still can occur, especially in patients who have suffered a stroke or another disease process that affects the brain.  

Acute Cerebellar Ataxia Symptoms

Although ataxia, or an unsteady gait, can occur after damage to any part of the central nervous system, damage to the cerebellum causes distinct symptoms.

If you have acute cerebellar ataxia, you may walk with your feet farther apart. This is clinically referred to as a "broadened base."

Often with ACA, you will appear to walk as if you are drunk. Since drinking alcohol affects the main nerve cells in the cerebellum, it is no coincidence that walking with these two conditions looks similar. The difference is that stumbling while intoxicated is usually reversible and goes away once the alcohol has processed through your system.

Other common symptoms of acute cerebellar ataxia include:

• Clumsy or slurred speech
• Repetitive eye movements
• Uncoordinated eye movements
• Swaying hands when reaching for an object
• Difficulty sitting up or maintaining posture

Causes

Because ataxia itself can be due to a variety of different causes, acute cerebellar ataxia often needs a full diagnostic workup in order to rule out any potentially life-threatening causes.

ACA in children, particularly those under the age of 3, is most often caused by a virus. Symptoms can occur within several days or weeks after infection.

The most common viruses that cause ACA in children are:

• Chicken pox
• Coxsackievirus
• Epstein-Barr virus/mononucleosis
• Echovirus
• Mumps

Other causes of acute cerebellar ataxia include but are not limited to:

• Abscess of the cerebellum
• Alcohol, medicines, insecticides, and illicit drugs
• Bleeding into the cerebellum
• Multiple sclerosis (MS)
• Strokes of the cerebellum
• Vaccination
• Trauma to head and neck
• Certain diseases associated with some cancers (paraneoplastic disorders)
• human immunodeficiency virus (HIV)
• Vitamin deficiencies, particularly thiamine, cobalamin, vitamin E, zinc, and folate
• Gluten sensitivity

Diagnosis

To diagnose the cause of acute cerebellar ataxia, your doctor will conduct a full examination and take a thorough history. They will ask if you have recently been sick or have had a head injury. They may also ask about drug and alcohol use.

After taking your history, your doctor will conduct a neurological examination to help determine the parts of the nervous system that are most affected.

The neurological examination can include a finger-to-nose test or a finger-to-finger test, in which you either touch the tips of your finger either to your nose or to the finger of the opposite hand.

You may be asked to slide your heel along your shin up to the knee while lying down. Your doctor may also test for the Romberg sign, which is the tendency to fall down while standing with your eyes closed.

Your doctor may have you hold a full glass of water with a steady hand without any water spilling. If the water spills, that can be a sign your cerebellum is affected.

After a thorough examination, your doctor may also order other tests which can include:

• Computed tomography (CT) scan of the head
• Magnetic resonance imaging (MRI) of the head
• Spinal tap
• Blood work to test for infections caused by viruses or bacteria, and/or vitamin deficiencies

Treatment

Treatment for acute cerebellar ataxia depends on the cause:

• Viral infection: For ACA caused by a recent viral infection, no treatment may be necessary, such as in the case of chicken pox. Some infections may need to be treated with antibiotics or antivirals.
• Trauma: For trauma to the head that involves bleeding or swelling, surgery may be necessary.
• Swelling or inflammation: If the ataxia is caused by swelling or an inflammatory disease such as multiple sclerosis, corticosteroids may be needed.
• Stroke: For a stroke, you may be prescribed blood thinners.
• Gluten sensitivity: You may need to eliminate gluten (proteins in grains such as wheat) from your diet.
• Vitamin deficiencies: You may need to change your diet or add supplements

Prognosis

If your acute cerebellar ataxia was caused by a recent viral infection, you should make a full recovery without treatment within a few months. If your child is affected by ACA due to a virus, they may simply need time and support to recover.

ACA caused by a stroke, bleeding, or infections may cause permanent symptoms and require further treatment, such as medication or physical therapy.

Coping

Experiencing permanent symptoms of ACA can put you at a higher risk for anxiety and depression. Seeing a therapist may help you manage your life in a way that doesn’t diminish its quality.

You may also find that a support group may make you feel less alone. Talking with others who have similar struggles can help you find ways to live with your symptoms and cope with the unpredictability of life with a chronic illness.

Summary

Acute cerebellar ataxia occurs when an injury or disease process affects the cerebellum of the brain, leading to a sudden loss of muscle-movement control or balance. It occurs most often in children and can be caused by viral illnesses, trauma, inflammatory conditions, or stroke.

ACA is diagnosed through a neurological examination, imaging, and blood tests. Treatment depends on the cause. If caused by a virus, ACA often resolves with only supportive care.

A Word From Verywell

Although concerning, most episodes of acute cerebellar ataxia resolve in a short time. If you or your child experience symptoms of ataxia, it is important to see your doctor to get a proper diagnosis and to begin a treatment plan, if necessary.

Seeking medical help early on can help prevent further—or permanent—damage.