From the Guidelines
For a man with new onset cerebellar ataxia, I recommend a comprehensive laboratory workup including complete blood count (CBC), thyroid-stimulating hormone (TSH), B12, calcium, electrolytes, creatinine, alanine transaminase (ALT), lipid panel, and hemoglobin A1c (HbA1c) as suggested by the most recent guidelines 1.
Laboratory Tests
The following laboratory tests are essential to identify the underlying cause of cerebellar ataxia:
- Complete blood count (CBC) to rule out infections or bleeding disorders
- Thyroid function tests, including TSH, to evaluate for thyroid dysfunction
- Vitamin B12 levels to assess for deficiency
- Calcium and electrolyte levels to evaluate for electrolyte imbalances
- Creatinine and ALT to assess for kidney and liver function
- Lipid panel to evaluate for dyslipidemia
- Hemoglobin A1c (HbA1c) to assess for diabetes
Additional Tests
Additional tests that may be considered include:
- Syphilis serology (RPR/VDRL) to rule out syphilis
- HIV testing to rule out HIV infection
- Heavy metal screening to rule out heavy metal toxicity
- Genetic testing for hereditary ataxias to evaluate for genetic causes
- Cerebrospinal fluid analysis to evaluate for inflammatory or infectious causes
- Alcohol levels and toxicology screening to rule out substance-related causes
Importance of Early Identification
Early identification of the underlying cause of cerebellar ataxia is crucial for appropriate management, as some etiologies like vitamin deficiencies or autoimmune conditions are potentially treatable, while others may require symptomatic management or genetic counseling 1.
From the Research
Laboratory Tests for Cerebellar Ataxia
To diagnose cerebellar ataxia, several laboratory tests can be considered:
- Complete blood count (CBC) to rule out infections or inflammatory conditions 2
- Electrolyte panel to check for electrolyte imbalances that may cause ataxia 2
- Liver function tests (LFTs) to evaluate for liver disease that may contribute to ataxia 2
- Vitamin B12 level to assess for deficiency, which can cause cerebellar ataxia 3
- Thyroid function tests (TFTs) to check for thyroid disorders that may cause ataxia 2
- Toxicology screen to rule out substance-induced ataxia 2
- Infectious disease testing (e.g., Lyme disease, HIV) to evaluate for infectious causes of ataxia 2
- Genetic testing to identify hereditary causes of cerebellar ataxia, such as autosomal dominant or recessive ataxias 4, 5
- Imaging studies, such as MRI, to evaluate for structural lesions or degenerative changes in the cerebellum 3, 6
Additional Considerations
When evaluating a patient with new-onset cerebellar ataxia, it is essential to consider the following:
- Family history to assess for hereditary causes of ataxia 4, 5
- Medical history to evaluate for underlying conditions that may contribute to ataxia 2
- Medication history to rule out drug-induced ataxia 2
- Physical examination to assess for signs of cerebellar dysfunction, such as dysmetria, dyscoordination, and gait ataxia 6