Management and Treatment of Sensory Ataxia

Diagnostic Workup to Guide Treatment

The American College of Radiology recommends MRI of the cervical and thoracic spine without IV contrast as the primary imaging modality to evaluate the dorsal columns of the spinal cord for compressive myelopathy, B12/copper deficiency, or tabes dorsalis neurosyphilis 1, 2, 3, 4
Add IV contrast if inflammatory, infectious, or neoplastic causes are suspected, as recommended by the American College of Radiology 2, 3
Spinal cord atrophy on MRI may be a helpful diagnostic finding in degenerative ataxia, according to the American College of Radiology 1, 2
Diagnostic confirmation relies primarily on clinical evaluation and electrodiagnostic testing (nerve conduction studies and EMG) to document large fiber sensory neuropathy or dorsal root ganglion involvement, as stated by the American College of Radiology 1, 2, 3, 4
Targeted ultrasound can detect changes in nerve size in some ataxic neuropathies, though this remains investigational, according to the American College of Radiology 1, 2, 3, 4

Vitamin B12 deficiency should be treated with replacement therapy using B12 supplementation, as recommended by the American College of Radiology 2, 3
Copper deficiency should be treated with copper supplementation, according to the American College of Radiology 2, 3
Neurosyphilis (tabes dorsalis) should be treated with antibiotic therapy, as stated by the American College of Radiology 2, 3
Compressive myelopathy should be treated with surgical decompression when indicated, according to the American College of Radiology 2, 3
Autoimmune sensory ataxic neuropathies may be considered for immunotherapy, though evidence is limited, as noted by the American College of Radiology 1, 2, 3, 4

Emphasize visual compensation techniques, as sensory ataxia worsens dramatically with eye closure (positive Romberg test), as recommended by the American College of Radiology 1, 2, 3, 4, 5
Prescription of appropriate assistive devices and orthoses improves balance and mobility, according to Praxis Medical Insights 6
Walking aids (canes, walkers) provide additional sensory feedback and stability, as stated by Praxis Medical Insights 6
Ankle-foot orthoses may improve proprioceptive input and gait stability, according to Praxis Medical Insights 6
Balance training programs can improve stability in patients with ataxia, as recommended by Praxis Medical Insights 6
Postural training improves trunk control, according to Praxis Medical Insights 6
Task-oriented upper limb training improves reaching and fine motor control, as stated by Praxis Medical Insights 6

Do not mistake sensory ataxia for cerebellar ataxia—sensory ataxia dramatically worsens with eye closure (positive Romberg), while cerebellar ataxia does not, as noted by the American College of Radiology and Praxis Medical Insights 1, 2, 3, 4, 6, 5
Recognize that sensory ataxia results from damage to dorsal root ganglia, dorsal columns, or peripheral sensory nerves—not the cerebellum, as stated by the American College of Radiology 1, 2, 3, 4
Always investigate for treatable causes first (B12, copper, neurosyphilis, compression) before concluding the condition is idiopathic, as recommended by the American College of Radiology 2, 3

Functional independence can be maintained longer through aggressive rehabilitation and appropriate assistive device use, according to Praxis Medical Insights 6