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Clinical Characteristics of the Late Recovery from Posttraumatic Gait Ataxia

We examined 75 consecutive patients with closed head trauma and found that 15 (20%) had moderate to severe gait ataxia (GA) 1-8 months after injury. Evaluation over 4 years revealed that the GA improved in six patients, and was persistent in nine others. All patients with chronic GA also displayed ocular motor abnormalities and/or large amplitude intention tremor when first and later examined. Those in whom GA disappeared never displayed eye movement abnormalities or tremor. The findings suggest that ocular motor abnormalities and/or intention tremor are poor prognostic signs for recovery from posttraumatic gait ataxia, and that posttraumatic gait ataxia without associated ocular motor or cerebellar tract injury has a better prognosis and might eventually disappear. The data suggest that damage to cerebellar outflow tracts, ocular motor nuclei, or fascicles may be irreversible whereas intrinsic cerebellar injury might be reversible.