In cerebellar ataxia, morphologic changes (atrophy) and signal alterations primarily involve the cerebellum and brainstem. These findings are typically adequately evaluated on MRI without IV contrast; however, if there is concern for an inflammatory or neoplastic cause of cerebellar ataxia, contrast-enhanced imaging should be included. Advanced MRI techniques such as DWI/diffusion-tensor imaging and spectroscopy do not require contrast administration and have shown promise in detecting early changes in ataxia and may also be useful in distinguishing between some ataxia subtypes in some studies [82-84]. MRI Head Without IV Contrast MRI of the head is the preferred initial imaging modality for the evaluation of patients with cerebellar ataxia. In cerebellar ataxia, morphologic changes (atrophy) and signal alterations primarily involve the cerebellum and brainstem. These findings are typically adequately evaluated on MRI without IV contrast. Lack of contrast, however, may impair the ability to distinguish between degenerative and inflammatory/infectious causes of cerebellar ataxia. Advanced MRI techniques such as DWI/diffusion-tensor imaging and spectroscopy do not require contrast administration and have shown promise in detecting early changes in ataxia and may also be useful in distinguishing between some ataxia subtypes in some studies [82-84]. Variant 7: Adult. Chronic disequilibrium with signs of sensory or proprioceptive ataxia. Initial imaging. Disequilibrium refers to a sensation of imbalance, unsteadiness, or instability. Symptoms of disequilibrium may result from neurodegeneration or inflammation involving the spinocerebellar tracts, dorsal columns of the spinal Dizziness and Ataxia cord, dorsal root ganglia, or more peripheral sensory nerves. In contrast to cerebellar ataxia (see Variant 6), sensory or proprioceptive ataxia indicates loss of coordination due to loss of normal position sense and is characterized by worsening with closed eyes (eg, Romberg test).
Dizziness and Ataxia. In cerebellar ataxia, morphologic changes (atrophy) and signal alterations primarily involve the cerebellum and brainstem. These findings are typically adequately evaluated on MRI without IV contrast; however, if there is concern for an inflammatory or neoplastic cause of cerebellar ataxia, contrast-enhanced imaging should be included. Advanced MRI techniques such as DWI/diffusion-tensor imaging and spectroscopy do not require contrast administration and have shown promise in detecting early changes in ataxia and may also be useful in distinguishing between some ataxia subtypes in some studies [82-84]. MRI Head Without IV Contrast MRI of the head is the preferred initial imaging modality for the evaluation of patients with cerebellar ataxia. In cerebellar ataxia, morphologic changes (atrophy) and signal alterations primarily involve the cerebellum and brainstem. These findings are typically adequately evaluated on MRI without IV contrast. Lack of contrast, however, may impair the ability to distinguish between degenerative and inflammatory/infectious causes of cerebellar ataxia. Advanced MRI techniques such as DWI/diffusion-tensor imaging and spectroscopy do not require contrast administration and have shown promise in detecting early changes in ataxia and may also be useful in distinguishing between some ataxia subtypes in some studies [82-84]. Variant 7: Adult. Chronic disequilibrium with signs of sensory or proprioceptive ataxia. Initial imaging. Disequilibrium refers to a sensation of imbalance, unsteadiness, or instability. Symptoms of disequilibrium may result from neurodegeneration or inflammation involving the spinocerebellar tracts, dorsal columns of the spinal Dizziness and Ataxia cord, dorsal root ganglia, or more peripheral sensory nerves. In contrast to cerebellar ataxia (see Variant 6), sensory or proprioceptive ataxia indicates loss of coordination due to loss of normal position sense and is characterized by worsening with closed eyes (eg, Romberg test).