Cerebellar atrophy is a disease of the small brain of a progressive, but not rapid, character with degenerative changes. The process is caused by trophic disturbances. Pathology is clearly expressed in the anamnesis and occurs for a variety of reasons. More often diagnosed after 40 years.
What happens with atrophy?
Purkinje cells, the large nerve cells of the cerebellar cortex, are the first to die. Nerve fibers lose their envelope - fiber demyelination occurs in both the central and peripheral nervous systems. The dentate nuclei of the cells that make up the cerebellum also die.
Cerebellum, or cerebellum: general concepts
In a newborn, cerebellum weight is about 20 g - 5% of body weight. By five months, the mass has tripled. At 15, the cerebellum reaches 150 g and does not grow anymore. In appearance, it resembles the hemisphere of the brain, for which it is also called the small brain. Located in the posterior cranial fossa. From above it is covered by the occipital lobes of the brain, under the cerebellum is the medulla oblongata and the bridge.
Through its fibers of white matter, the cerebellum is connected to all parts of the cerebrum. It has three departments:
- The most ancient in origin is the hook.
- Old - a worm that is located in the midline of the cerebellum.
- New - two hemispheres that resemble large hemispheres. Evolutionarily this is the most developed part. In each hemisphere there are three lobes, and each of them corresponds to a section of the worm. The cerebellar hemispheres have gray and white matter. Gray - bark, white - fibers with cores: spherical, serrated, tires. These nuclei serve for the conduction of pulses and play a large role.
Cerebellar function
The main function of the cerebellum:
- motor coordination and maintenance of musculoskeletal tone;
- smoothness and proportionality of movements;
- body balance is constant;
- the center of gravity;
- muscle tone is regulated and redistributed correctly.
Due to the cerebellum, the muscles work smoothly and can perform any daily movements. For the most part, the cerebellum is responsible for the tone of the extensor muscles.
In addition, the cerebellum is involved in unconditioned reflexes: through its fibers, it is connected to receptors in different parts of the body. When an irritant acts from the receptor, a nerve impulse enters the cerebellum , after which a response is instantly given in the cerebral cortex.
With atrophy, nerve fibers are damaged. The coordination, gait is disturbed and the balance of the body is disturbed. These characteristic symptoms are combined by the general term “cerebellar syndrome”.
This syndrome is characterized by disorders of a vegetative nature, motor sphere, muscle tone, which immediately impairs the patient's quality of life.
Causes of atrophy
With atrophy, the affected area does not receive nutrition and oxygen. Irreversible processes develop, the size of the organ decreases, and it is depleted.
Among the possible causes of cerebellar atrophy are the following:
- Meningitis. This is an infectious disease of the membranes of the brain in which inflammation affects different parts of the brain. Cerebellar atrophy develops due to vascular damage and the direct influence of bacterial toxins.
- Tumors in the vicinity of the cerebellum (posterior cranial fossa). As the tumor grows, it presses on the cerebellum and nearby parts of the brain. Tissue blood supply suffers and atrophy can begin.
- Hyperthermia, heat stroke. At high temperatures, the trophism of brain tissues and nerve cells is disrupted and leads to their death.
- Atherosclerosis of the vessels of the brain. The mechanism of trophic disturbance is associated with the same blood flow disturbance. Nerve cells begin to die, and disorders appear. The lumen of the arteries narrows and it loses its elasticity. In addition, endothelium is damaged in the vessels with the development of atherosclerotic plaques here.
- Diabetic capillaropathy in diabetes.
- Thrombosis and blockage of the gaps of blood vessels that occur with vascular vasculitis. It can also cause malnutrition and death of neurons.
- Complications after a stroke are the appearance of ischemic areas, when there is a lack of blood in them, causing them to die and, as a result, cerebellar atrophy.
- TBI.
- Various hemorrhages - the formation of scars and cysts ends, which also violates the trophic tissue.
- Vitamin E vitamin deficiency
- Taking certain medications, alcohol, and toxic substances can trigger the development of diffuse atrophy of the brain and cerebellum.
In most cases, the cause of atrophy cannot be determined. Cerebellar diseases are congenital and acquired.
Congenital atrophy
Hereditary pathology of the cerebellum is a collective syndrome, is rare.
Congenital cerebral atrophy is a sporadic case, and children are usually diagnosed with cerebral palsy. Only with the development of a similar clinical picture in several family members the hereditary-family nature of the disease usually becomes apparent.
Types of atrophy
Atrophy of the cerebellar worm occurs most often. The cerebellar worm is responsible for conducting nerve impulses of an informational nature between the brain and various parts of the body, and the balance of the center of gravity. Due to its defeat, vestibular disorders develop, imbalances and coordination of movements occur both when walking and at rest, there is a constant tremor.
Diffuse atrophy of the cerebellum means the development of atrophy at the same time in other parts of the brain. Often this happens with age. The most common manifestations of this are Alzheimer's and Parkinson's.
Atrophy of the cerebellar hemispheres is manifested by the deviation of the patient when walking from a given direction towards a pathological focus. This is especially evident when trying to make a turn.
Atrophies of the cerebellar hemisphere are most often secondary, cross-linked. They occur on the opposite side of the affected hemisphere with hemiplegia, if the pathology arose in embryogenesis or at an early age up to three years. Hemiplegia - paralysis of half the body, clinically it obscures the cerebellar symptoms. Atrophy of the cerebellar hemispheres is accompanied by destruction of the nervous tissue throughout the brain. In such cases, subatrophy of the cerebral hemispheres occurs and is clinically manifested in the onset of senile dementia.
Atrophy of the hemisphere of the cerebellum (this is the same hemisphere) may be associated with the presence of tumors, cysts, heart attacks in this area. If tumors cystically regenerate, they are benign. Since the growth of the neoplasm is slow, cerebellar dysfunction manages to be compensated by the cerebral cortex.
Hemispheric cerebellar symptoms manifest as unilateral ataxia and hypotension in one hand or arm and leg. But more often the disease is manifested by attacks of headaches with or without vomiting, which gradually increase in severity.
A corneal reflex falls out on the side of the tumor. At different stages of the pathology, nystagmus develops - it is also more pronounced on the side of the lesion. With proliferation, the tumor can affect the cranial nerves, which already give their symptoms of damage.
An essential characteristic of cerebellar cortical atrophy is its development in the elderly. Visual signs are characterized by gait instability, inability to maintain a vertical position without support and support.
Hand movements (fine motor skills) are gradually disturbed: it becomes difficult to write, use cutlery during meals, and so on. Violations of this kind are symmetrical. Then the tremor of the head, limbs and later the whole body joins. Tremor, or trembling, is small, rhythmic, but involuntary movements of the body or its parts. With a decrease in muscle tone, the functioning of the speech apparatus is disrupted.
Symptomatic manifestations
Atrophy of the cerebellum of the brain is destructive for the patient, because with the death of nerve cells, pathological processes become irreversible.
Cerebellar disorders combine several groups of disorders:
- The first group. Violations of the smoothness of limb movements (mainly hands). This is manifested by trembling hands at the end of any purposeful movement.
- Speech Disorders.
- Arbitrary movements and speech become slow. Next, the handwriting changes. Since the cerebellum is associated with motor acts, impaired functioning is impaired movement.
Symptoms of cerebellar atrophy: asinergy of the muscles of the legs and torso, while difficulties arise when the patient tries to get up from a lying position and sit down. These are very common signs of an affected cerebellum, and they speak of a disorder of synergy of muscles (consistency of work) belonging to different muscle groups when they are involved in the same motor act. The combination of simple and complex movements is completely messed up and broken.
Signs of cerebellar atrophy:
- The occurrence of discoordination of movements, the appearance of paralysis and various speech disorders. People cannot move smoothly, they are swaying in different directions, the gait becomes insecure.
- Tremor and nystagmus (involuntary oscillatory movements of the eyeballs during their abduction). Tremor is present constantly - in motion and at rest. Speech becomes chanted, dysarthria. What does this mean? A person with dysarthria has difficulty pronouncing words or distorts them with fuzzy pronunciation.
- Chanting or telegraphic speech is possible. It is rhythmic, but the stresses are not put in meaning, but correspond only to rhythm.
- Muscle tone is reduced due to atrophy of nerve fibers.
- Dysdiadochokinesis is such a violation of coordination when the patient cannot perform fast alternating movements.
- Dysmetry - the patient cannot control the amplitude of the movement, i.e., accurately determine the distance between the subject and himself.
- Hemiplegia occurs from paralysis.
- Ophthalmoplegia - paralysis of eyeballs, may be temporary.
- Hearing impairment.
- Swallowing disorder.
- Ataxia - unsteadiness of gait; may be temporary or permanent. With such a drunken gait, the patient brings to the side of the lesion.
- Sharp cephalgia, with nausea and vomiting, dizziness due to increased intracranial pressure (ICP), and drowsiness are also possible.
- Hyporeflexia or areflexia - a decrease or complete loss of reflexes, urinary and fecal incontinence. Often possible deviations in the psyche.
Diagnostic measures
First, a neurologist conducts a study of reflexes to identify the localization of a central nervous system lesion.
Also assigned:
- MRI of cerebellar atrophy allows you to find out in detail all changes in the cortex and subcortex. The diagnosis can be determined in the early stages of the disease. This method is the most reliable.
- CT gives a complete picture of changes after strokes, reveals their cause, indicates the location of cystic formations, i.e., all causes of tissue trophic disorders. Assign for contraindications to MRI.
- Ultrasound examination is used to diagnose extensive brain damage in strokes, head injury, injuries and age-related changes. It can identify the zone of atrophy and determine the stage of the disease.
Complications and consequences
The consequences of cerebellar atrophy are irreversible. In the absence of body support at the initial stage, the end may be a complete degradation of the personality, both social and physiological.
As the pathology progresses, it is impossible to reverse the destruction processes, but there is the possibility of inhibition, symptom freezing, in order to prevent further progression. A patient with cerebral cerebellum atrophy begins to feel inferior, as he appears: impaired, drunken gait, all movements become insecure, he cannot stand without support, he is hard to walk, speech is disturbed due to impaired tongue movements, phrases are built incorrectly, he cannot clearly express his thoughts.
Gradually, social degradation occurs. The trembling of the whole body becomes constant, a person can no longer do things that were elementary for him before.
Treatment principles
Treatment of cerebellar atrophy is only symptomatic and it is aimed at correcting existing disorders and preventing their progression. Patients are unable to serve themselves, they need outside care, and they are issued disability benefits.
Diagnosis and treatment of such patients after examination is best done at home. The familiar environment eases the patient's condition, the novelty leads to stress.
Care must be thorough. Self-medication and the use of traditional medicine recipes are strongly not recommended. This will only aggravate the condition. At home, the patient should not only lie, he must be loaded mentally and physically. Of course, within feasible limits for him.
It is desirable for the patient to move more in order to occupy himself with something and find work, to lie down less during the day.
Inpatient care is needed only with acute forms of atrophy.
If there is no one to care for the patient, the social welfare authorities are obliged to arrange it in a specialized boarding school. That is, in any case, the development of the disease should not be allowed to drift.
A balanced diet, a clear daily routine is important. Naturally, smoking and alcohol must be quit. Treatment is also required to restore movement and relieve tremor.
According to the testimony, surgery may be necessary - this will be determined by the doctor. Mandatory prescription of drugs that improve blood supply to the brain, improve metabolism, to provide nutrition and oxygen to nerve cells.
There are a lot of such drugs - these are nootropics, and angioprotectors, and antihypertensives and so on.
Methods to eliminate cerebral atrophy do not exist, because nerve tissue is not able to recover.
To eliminate psychotic disorders, psychotropic drugs can be prescribed: "Teralen", "Alimemazine", "Levomepromazin", "Thioridazine", "Sonapax". They will help the patient reduce tension, relieve fear and anxiety, improve mood, because such patients feel their failure.
Regular examinations and examinations by a neurologist are necessary. This will allow you to control the effectiveness of the treatment. It is also necessary to check the patient's condition, provide him with recommendations, and if necessary, correct treatment.
What are the forecasts?
Today there is no way to prevent the disease. The prognosis of cerebellar atrophy is disappointing, as nerve cells have died and will no longer be restored. But today it is possible to prevent their further degradation.
Preventive actions
As such, specific prophylaxis does not exist. Complete cure is excluded.
Patient's life with good care and supportive treatment can only be brought a little closer to normal and prolong it as far as possible.
The creation of comfortable conditions for the patient depends only on loved ones, if someone in the family is ill. And doctors can only help to prevent the disease from progressing rapidly.