Cerebellar atrophy

Cerebellar atrophy is a clearly expressed, rapidly progressing pathology that develops due to disruptions in metabolic processes, often associated with structural anatomical deviations from the norm.

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Causes cerebellar atrophy

The cerebellum itself is an anatomical formation (even more ancient than the midbrain), consisting of two hemispheres, in the connecting groove between which is the cerebellar vermis.

The causes of cerebellar atrophy are very different and include a fairly extensive list of diseases that can affect the cerebellum and its associated connections. Based on this, it is quite difficult to classify the causes that led to this disease, but it is worth highlighting at least some:

• Consequences of meningitis.
• Brain cysts located in the posterior cranial fossa area.
• Tumors of the same localization.
• Hyperthermia. Sufficiently long-term thermal stress for the body (heat stroke, high temperature readings).
• The result of atherosclerosis.
• Consequences of a stroke.
• Almost all pathological manifestations are associated with processes occurring in the posterior cranial region.
• Metabolic disorders.
• With intrauterine damage to the cerebral hemispheres. The same reason can become an impetus for the development of cerebellar atrophy in a child in infancy.
• Alcohol.
• Reaction to certain medications.

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Symptoms cerebellar atrophy

The symptoms of this disease, as well as its causes, are quite extensive and are directly related to the diseases or pathologies that caused it.

The most common symptoms of cerebellar atrophy are:

• Dizziness.
• Sharp headaches.
• Nausea leading to vomiting.
• Drowsiness.
• Hearing impairment.
• Mild or significant disturbances in the walking process (unsteadiness in walking).
• Hyporeflexia.
• Increased intracranial pressure.
• Ataxia. Disorder of coordination of voluntary movements. This symptom is observed both temporarily and permanently.
• Ophthalmoplegia. Paralysis of one or more cranial nerves that innervate the eye muscles. May be temporary.
• Areflexia. Pathology of one or more reflexes, which is associated with a violation of the integrity of the reflex arc of the nervous system.
• Enuresis is urinary incontinence.
• Dysarthria. A disorder of articulate speech (difficulty or distortion of spoken words).
• Tremor. Involuntary rhythmic movements of individual parts or the entire body.
• Nystagmus. Involuntary rhythmic oscillatory movements of the eyes.

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Forms

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Cerebellar vermis atrophy

The cerebellar vermis is responsible for the balance of the body's center of gravity in the human body. For healthy functioning, the cerebellar vermis receives an information signal that goes along the spinocerebellar pathways from various parts of the body, the vestibular nuclei and other parts of the human body, which are comprehensively involved in the correction and maintenance of the motor apparatus in spatial coordinates. That is, it is the atrophy of the cerebellar vermis that leads to the collapse of normal physiological and neurological connections, the patient has problems with balance and stability, both when walking and at rest. By controlling the tone of reciprocal muscle groups (mainly the muscles of the trunk and neck), the cerebellar vermis weakens its functions when it atrophies, which leads to movement disorders, constant tremor and other unpleasant symptoms.

A healthy person tenses the muscles of the legs when standing. When there is a threat of falling, for example to the left, the left leg moves in the direction of the expected fall. The right leg is lifted off the surface as if jumping. With atrophy of the cerebellar vermis, the connection in the coordination of these actions is disrupted, which leads to instability and the patient can fall even from a small push.

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Diffuse atrophy of the brain and cerebellum

The brain with all its structural components is the same organ of the human body as everything else. Over time, a person ages, and his brain ages with him. Brain activity is disrupted and, to a greater or lesser extent, its functionality atrophies: the ability to plan and control one's actions. This often leads an elderly person to a distorted idea of the norms of behavior. The main cause of atrophy of the cerebellum and the entire brain is the genetic component, and external factors are only a provoking and aggravating category. The difference in clinical manifestations is associated only with the predominant damage to one or another area of the brain. The main general manifestation of the course of the disease is that the destructive process gradually progresses, up to a complete loss of personal qualities.

Diffuse atrophy of the brain and cerebellum can progress due to numerous pathological processes of various etiologies. At the initial stage of development, diffuse atrophy, in its symptoms, is quite similar to late cortical atrophy of the cerebellum, but over time, other symptoms more inherent to this particular pathology join the basic symptoms.

The impetus for the development of diffuse atrophy of the brain and cerebellum can be either a traumatic brain injury or a chronic form of alcoholism.

This disorder of brain function was first described in 1956, based on behavioral monitoring and, after death, direct study of the brain itself of American soldiers who had been subjected to post-traumatic autonomic stress for a fairly long time.

Today, doctors differentiate three types of brain cell death.

• Genetic type - natural, genetically programmed process of neuron death. A person ages, the brain gradually dies.
• Necrosis – the death of brain cells occurs as a result of external factors: contusions, traumatic brain injuries, hemorrhages, ischemic manifestations.
• "Suicide" of a cell. Under the influence of certain factors, the cell nucleus is destroyed. Such pathology can be congenital or acquired under the influence of a combination of factors.

The so-called "cerebellar gait" is in many ways reminiscent of the movement of a drunk. Due to impaired coordination of movement, people with cerebellar atrophy, and the brain as a whole, move uncertainly, they sway from side to side. This instability is especially evident when it is necessary to make a turn. If diffuse atrophy has already passed into a more severe, acute stage, the patient loses the ability not only to walk, stand, but also to sit.

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Cerebellar cortex atrophy

Another form of this pathology is described quite clearly in medical literature – late atrophy of the cerebellar cortex. The primary source of the process that destroys brain cells is the death of Purkinje cells. Clinical studies show that in this case, demyelination of fibers (selective damage to the myelin layers located in the amniotic zone of the endings of both the peripheral and central nervous systems) of the dentate nuclei of cells, which make up the cerebellum, occurs. The granular layer of cells usually suffers little. It undergoes changes in the case of an already acute, severe stage of the disease.

Degeneration of cells begins with the upper zone of the worm, gradually expanding to the entire surface of the worm and then to the hemispheres of the brain. The last zones that are subject to pathological changes, when the disease is neglected and its manifestation is acute, are the olives. During this period, processes of retrograde (reverse) degeneration begin to occur in them.

The exact etiology of such damage has not been identified to date. Doctors assume, based on their observations, that the cause of cerebellar cortex atrophy may be various types of intoxication, the development of cancerous tumors, as well as progressive paralysis.

But, as sad as it may sound, in most cases it is not possible to determine the etiology of the process. It is only possible to state changes in certain areas of the cerebellar cortex.

An essential characteristic of cerebellar cortex atrophy is that, as a rule, it begins in patients already at an older age, and is characterized by a slow progression of the pathology. Visual signs of the disease begin to manifest themselves in gait instability, problems when standing without support and support. Gradually, the pathology affects the motor functions of the hands. It becomes difficult for the patient to write, use cutlery, and so on. Pathological disorders, as a rule, develop symmetrically. Tremors of the head, limbs, and the entire body appear, the speech apparatus also begins to suffer, muscle tone decreases.

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Complications and consequences

The consequences of cerebellar atrophy are devastating for the patient, as irreversible pathological processes occur during the rapid development of the disease. If the patient's body is not supported at the initial stage of the disease, the final result may be the complete degradation of the person as an individual - this is in the social sense and a complete inability to act adequately - in the physiological sense.

At a certain stage of the disease, the process of cerebellar atrophy can no longer be reversed, but it is possible to freeze the symptoms, preventing them from progressing further.

A patient with cerebellar atrophy begins to feel uncomfortable:

• There is uncertainty in movements and a “drunk” gait syndrome.
• The patient has difficulty walking and standing without support or the help of loved ones.
• Problems with speech begin: slurred speech, incorrect construction of sentences, inability to clearly express one’s thoughts.
• Manifestations of degradation of social behavior gradually progress.
• Tremors of the limbs, head and the entire body of the patient begin to be visualized. It becomes difficult for him to do seemingly elementary things.

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Diagnostics cerebellar atrophy

To establish a correct diagnosis, a patient with the above symptoms must consult a neurologist, and only he can make a definitive diagnosis.

Diagnosis of cerebellar atrophy includes:

• A neuroimaging method that involves a doctor visually examining the patient and checking his nerve endings for a reaction to external stimuli.
• Identification of the patient's medical history.
• Genetic predisposition to this category of diseases. That is, whether there were cases of relatives suffering from similar diseases in the patient's family.
• Computed tomography helps in diagnosing cerebellar atrophy.
• A neurologist may refer a newborn for an ultrasound examination.
• MRI is at a fairly high level and with a high probability reveals this pathology of the cerebellum and brainstem, and shows other changes that fall within the study area.

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Treatment cerebellar atrophy

As sad as it may sound, it is impossible to carry out classical treatment of cerebellar atrophy. In the course of this disease, it is impossible to direct it to eliminate the cause of the pathology. Modern medicine today can only offer the patient treatment aimed at smoothing out the symptoms of the disease. That is, with the help of medication and other methods, the neurologist tries to stop the progressing disease and alleviate the general condition of the patient.

If the patient suffers from excessive excitability and irritability, or, on the contrary, shows complete apathy, the attending physician prescribes appropriate psychotropic drugs to such a patient.

Levomepromazine

This drug is used in the treatment of chronic melancholic states. It is also effective in various etiologies of excitations. In this case, the dosage in each specific case is prescribed individually.

Usually, the treatment course begins with a starting dose of 0.025 g, taken two to three times a day. Gradually, the dose is increased to 0.075–0.1 g daily. When the desired result is achieved, the dosage is reduced to a prophylactic amount of 0.05–0.0125 g.

If the patient is admitted with an acute form, a 2.5% solution of levomepromazine is administered intramuscularly at 1-2 ml. If clinically indicated, the dosage is increased from 0.1 g to 0.3 g per day. Side effects of the drug are mild. It is not recommended to use this medicine for people suffering from cardiovascular diseases, hypertension, blood problems.

Such drugs as alimemazine, teralen, thioridazine effectively reduce anxiety and fear, relieve tension.

Alimemazine

The drug is administered intravenously and intramuscularly. The daily dosage for adults is 10–40 mg. The daily dosage for children is 7.5–25 mg. Injections are given three to four times a day.

In acute manifestations of a psychiatric disease, for adults the starting daily dosage is 100-400 mg. But the quantitative component of the drug per day should not exceed: for adults - 500 mg, for the elderly - 200 mg.

This drug is ineffective in cases of obvious psychosis. It is used as a mild sedative. The drug alimemazine is contraindicated for patients with concomitant diseases: prostate pathology, impaired renal and hepatic function, hypersensitivity to the components of the drug. It is also not given to children under one year of age.

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Teralen

The daily dosage of the drug is two to eight tablets, depending on the severity of the symptoms. The drug is indicated for increased nervousness, sleep disorders, and other symptoms. You should not take this drug if you have increased hypersensitivity to the components of the drug, liver and kidney failure, Parkinsonism, and other diseases. It should not be given to children under seven years of age.

Thioridazine

In mild forms of fatigue, emotional decline, the drug is taken orally in a dosage of 30-75 mg per day. If moderate manifestations are recorded, the dosage is increased to 50-200 mg per day. If the disease of the cerebellar atrophy is expressed by an acute form of psychosis, manic-depressive state, the daily dosage is increased to 150-400 mg (in a polyclinic) and 250-800 mg - upon admission to the hospital. This drug should not be used by patients who have a history of severe cardiovascular diseases, comatose states of any etiology, traumatic brain injury and many others. Thioridazine is not recommended for pregnant women, mothers during lactation, children under two years of age, elderly people and people suffering from alcoholism, etc.

When severe neuroses appear, Sonapax is prescribed.

Sonapax

Recommended dosage:

• for mild mental disorders - 30-75 mg throughout the day.
• for moderate mental and emotional disorders - 50-200 mg throughout the day.
• if acute symptoms of the disorder appear - during outpatient treatment, a neurologist prescribes a daily dosage of 150-400 mg; if treatment is carried out in a hospital, the daily dosage may increase to 250-800 mg (under the supervision of a doctor).

For children aged four to seven years, the dosage is slightly lower and is 10-20 mg per day, divided into two to three doses; for children aged eight to 14 years, 20-30 mg per day three times a day; for teenagers aged 15 to 18 years, the dosage is increased to 30-50 mg per day.

Sonapax is contraindicated for patients who are in the acute stage of a depressive state, the drug is not prescribed to those who suffer from comatose states of various genesis, with severe damage to the cardiovascular system, with craniocerebral injuries and many other diseases. The full list of contraindications can be read in the accompanying instructions for the drug.

At the initial stage of the disease, it is advisable to treat the patient at home, in a familiar environment, since hospitalization is fraught with deterioration of the general condition of the patient. At the same time, it is necessary to create all the conditions for an active lifestyle. Such a person needs to move a lot, constantly find some kind of work, lie down less during the day. Only in acute forms of cerebellar atrophy is the patient placed in a hospital or a specialized boarding school, especially if there is no one to care for him at home.

Prevention

As such, there is no prevention of cerebellar atrophy. It is impossible to prevent this disease even based on the fact that medicine does not know the exact causes of its occurrence. Modern medications are able to maintain the psychosomatic and physiological state of the patient in a relatively satisfactory state, and in combination with good care can prolong his life, but are not able to cure.

If you have such a pathology in your family, try to see a neurologist more often. An examination will not be superfluous.

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Forecast

The prognosis for cerebellar atrophy is not encouraging. It is almost impossible to completely cure a patient with such a diagnosis. With the efforts of doctors and close relatives, the patient's life can only be slightly normalized and extended.

Cerebellar atrophy is not curable. If it happens, and trouble has come to your family, someone close to you has fallen ill, surround him with attention, create comfortable living conditions, and doctors will help ensure that the disease does not progress so much, and the patient feels satisfactory. Your care and love will help prolong his life, filling it with meaning.

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