Atrophy of the cerebellum is a disease of the small brain of a progressive, but not rapid, nature with degenerative changes. The process is caused by trophic disturbances. Pathology is pronounced in history and occurs for a variety of reasons. More often diagnosed after 40 years.
What happens in atrophy?
First of all, Purkinje cells, large nerve cells of the cerebellar cortex, die. Nerve fibers lose their sheath - demyelination of fibers occurs both in the central and in the peripheral nervous system. The dentate nuclei of the cells that make up the cerebellum also die.
Cerebellum, or cerebellum: general concepts
In a newborn, the weight of the cerebellum is about 20 g - 5% of body weight. By five months, the mass triples. At the age of 15, the cerebellum reaches 150 g and no longer grows. In appearance, it resembles the hemispheres of the brain, for which it is also called the small brain. It is 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 white matter fibers, the cerebellum is connected to all parts of the cerebrum. It has three departments:
- The most ancient 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. Each hemisphere has three lobes, and each of them corresponds to a part of the worm. The cerebellar hemispheres have gray and white matter. Gray - bark, white - fibers with nuclei: spherical, serrated, tires. These nuclei serve to conduct impulses and play a big role.
Cerebellar Functions
Main function of the cerebellum:
- motor coordination and maintenance of musculoskeletal tone;
- smoothness and proportionality of movements;
- body balance constantly;
- center of gravity;
- muscle tone is regulated and properly redistributed.
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 exposed to any stimulus, a nerve impulse enters the cerebellum from the receptor, after which a response is immediately given in the cerebral cortex.
In atrophy, nerve fibers are damaged. Violated coordination, gait and balance of the body. These characteristic symptomsare united under 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 with it 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. The blood supply to tissues suffers and atrophy may begin.
- Hyperthermia, heatstroke. At high temperatures, the trophism of brain tissues and nerve cells is disrupted and leads to their death.
- Atherosclerosis of cerebral vessels. The mechanism of trophic disturbance is associated with the same disturbance of blood flow. Nerve cells begin to die, and disorders appear. The lumen of the arteries narrows, and it loses its elasticity. In addition, the endothelium is damaged in the vessels with the development of atherosclerotic plaques here.
- Diabetic capillaropathy in diabetes mellitus.
- Thrombosis and blockage of the lumen of blood vessels that occur in vascular vasculitis. May also cause malnutrition and deathneurons.
- Complications after a stroke - the appearance of ischemic areas, when there is a lack of blood in them, causes their death and, as a result, atrophy of the cerebellum.
- TBI.
- Various hemorrhages - the formation of scars and cysts ends, which also disrupts tissue trophism.
- Vitamin E deficiency.
- The intake of certain drugs, alcohol, poisonous substances can trigger the development of diffuse atrophy of the brain and cerebellum.
In most cases, the cause of atrophy cannot be determined. Diseases of the cerebellum are congenital and acquired.
Congenital atrophy
Hereditary pathology of the cerebellum is a collective syndrome, rare.
Congenital atrophy of the cerebellum is sporadic and children are usually diagnosed with cerebral palsy. Only with the development of a similar clinical picture in several family members, the hereditary-familial nature of the disease usually becomes apparent.
Types of atrophy
Atrophy of the cerebellar vermis 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, the balance of the center of gravity. Because of its defeat, vestibular disorders develop, imbalance and coordination of movements occur both when walking and at rest, and a constant tremor occurs.
Diffuse atrophy of the cerebellum means the development of atrophy simultaneously in other parts of the brain. This often happens with age. The most common manifestations of this are diseasesAlzheimer's and Parkinson's.
Atrophy of the cerebellar hemispheres is manifested by the deviation of the patient when walking from a given direction towards the pathological focus. This is especially evident when trying to make a turn.
Atrophy of the cerebellar hemisphere is most often secondary, cross. They occur on the opposite side of the affected hemisphere with hemiplegia, if the pathology arose in embryogenesis or at an early age of up to three years. Hemiplegia - paralysis of half of the body, clinically it obscures 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 cerebellar hemisphere (this is the same hemisphere) may be associated with the presence of tumors, cysts, infarcts in this area. If the tumors become cystic, they are benign. Since the neoplasm grows slowly, cerebellar dysfunction has time to compensate for the cerebral cortex.
Hemispheric cerebellar symptoms manifest as unilateral ataxia and hypotension in an arm or arm and leg on one side. 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. As the tumor grows, it can also affect the cranial nerves, which already give their symptoms of the lesion.
An essential characteristic of atrophy of the cerebellar cortex is its development in the elderly. Visual signs are characterized by unsteady gait, the inability to maintain an upright position without support and support.
Gradually impaired hand movements (fine motor skills): it becomes difficult to write, use cutlery while eating, etc. 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 is devastating 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 movements of the limbs (mainly hands). This is manifested by hand trembling at the end of any purposeful movement.
- Speech disorders.
- Voluntary movements and speech become slow. Next, the handwriting changes. Since the cerebellum is associated with motor acts, a violation of its work is a movement disorder.
Symptoms of cerebellar atrophy: asynergy of the muscles of the legs and torso, while there are difficulties when the patient tries to rise from a lying position and sit down. These are very common signs of an affected cerebellum, and they speak of a disorder of muscle synergy (consistencywork) belonging to different muscle groups when they participate in the same motor act. The combination of simple and complex movements is completely disordered 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 stagger in different directions, their gait becomes unsteady.
- Tremor and nystagmus (involuntary oscillatory movements of the eyeballs during their abduction). Tremor is present all the time - in motion and at rest. Speech becomes slurred and dysarthric. What does this mean? A person with dysarthria finds it difficult to pronounce words or distorts them with a fuzzy pronunciation.
- Scanned or telegraphic speech possible. It is rhythmic, but the stresses are not placed according to the meaning, but correspond only to the rhythm.
- Muscle tone is reduced due to atrophy of nerve fibers.
- Dysdiadochokinesis is a violation of coordination when the patient cannot perform fast alternating movements.
- Dysmetria - the patient cannot control the amplitude of movement, i.e., accurately determine the distance between the object and himself.
- From paralysis comes hemiplegia.
- Ophthalmoplegia - paralysis of the eyeballs, may be temporary.
- Hearing impaired.
- Swallowing disorder.
- Ataxia - unsteady gait; may be temporary or permanent. With such a drunken gait, the patient is carried towards the lesion.
- Severe cephalalgias are also possible, with nausea and vomiting, dizziness due to rising intracranialpressure (ICP), drowsiness.
- Hyporeflexia or areflexia - reduction or complete loss of reflexes, urinary and fecal incontinence. Deviations in the psyche are often possible.
Diagnostic measures
First, the neurologist conducts a study of reflexes to identify the localization of the CNS lesion.
Also assigned:
- MRI of cerebellar atrophy allows you to find out in detail all the 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, that is, all the causes of tissue trophic disorders. Prescribed for contraindications to MRI.
- Ultrasound examination is used to diagnose extensive brain lesions in stroke, TBI, trauma and age-related changes. Can identify the area of atrophy and determine the stage of the disease.
Complications and consequences
The consequences of cerebellar atrophy are irreversible. In the absence of support for the body at the initial stage, the end may be the complete degradation of the personality, both social and physiological.
As the pathology progresses, it is impossible to reverse the processes of destruction, but there is the possibility of inhibition, freezing of symptoms in order to prevent further progression. A patient with atrophy of the cerebellum of the brain begins to feel inferior, becausehe appears: a disturbed, drunken gait, all movements become uncertain, he cannot stand without support, it is difficult for him to walk, speech is impaired due to violations of the movements of the tongue, phrases are built incorrectly, he cannot clearly express his thoughts.
Social degradation is gradually taking place. The trembling of the whole body becomes constant, a person can no longer perform elementary things for him before.
Principles of treatment
Treatment of cerebellar atrophy is only symptomatic and is aimed at correcting existing disorders and preventing their progression. Patients are unable to serve themselves, they need outside care, and they are issued a disability, an allowance.
The diagnosis and treatment of such patients after the examination is best done at home. The familiar environment relieves the patient's condition, the novelty leads to stress.
Care must be meticulous. It is strongly not recommended to self-medicate and use traditional medicine recipes. This will only aggravate the condition. At home, the patient should not only lie down, he must be loaded mentally and physically. Of course, within his limits.
It is desirable for the patient to move more in order to occupy himself with something and find work, lie less during the day.
Inpatient care is needed only for acute forms of atrophy.
If there is no one to take care of the patient, the social guardianship authorities are obliged to place him in a specialized boarding school. That is, in any case, the development of the disease should not be allowed to take its course.
Importantbalanced diet, a clear daily routine. Naturally, it is necessary to quit smoking and alcohol. Treatment is also required to restore movement and reduce tremors.
According to the indications, an operation may be necessary - this will be determined by the doctor. Be sure to prescribe drugs that improve blood circulation to the brain, improve metabolism in order 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.
There are no cures for cerebellar atrophy because the nerve tissue is unable to regenerate.
To eliminate psychotic disorders, psychotropic drugs can be prescribed: Teralen, Alimemazine, Levomepromazine, Thioridazine, Sonapax. They will help the patient to reduce tension, relieve fear and anxiety, improve mood, because such patients feel their failure.
Necessary regular examinations and examinations by a neurologist. 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 the 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 recover. But today it is possible to prevent their further degradation.
Prevention measures
There is no specific prevention as such. Completecure is ruled out.
The life of a patient with good care and supportive care can only be brought a little closer to normal and extended as much as possible.
The creation of comfortable conditions for the patient depends only on close people, if someone in the family is sick. And doctors can only help to prevent the disease from progressing quickly.
