CANVAS an update: Clinical presentation, investigation and management

Author:

Szmulewicz David J.1,McLean Catriona A.2,MacDougall Hamish G.3,Roberts Leslie4,Storey Elsdon5,Halmagyi G. Michael6

Affiliation:

1. Royal Victorian Eye & Ear Hospital, University of Melbourne, Melbourne, Australia

2. Department of Anatomical Pathology, Alfred Hospital, Melbourne, Australia

3. Vestibular Research Laboratory, School of Psychology, University of Sydney, Sydney, Australia

4. Department of Neuroscience, St Vincent's Hospital, Melbourne, Australia

5. Department of Neuroscience, Monash University, Melbourne, Australia

6. Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia

Abstract

Background: Cerebellar Ataxia with Neuropathy and bilateral Vestibular Areflexia Syndrome (CANVAS) is a multi-system ataxia which results in cerebellar ataxia, a bilateral vestibulopathy and a somatosensory deficit. This sensory deficit has recently been shown to be a neuronopathy, with marked dorsal root ganglia neuronal loss. The characteristic oculomotor clinical sign is an abnormal visually enhanced vestibulo-ocular reflex. Objective: To outline the expanding understanding of the pathology in this condition, as well as diagnostic and management issues encountered in clinical practice. Methods: Retrospective data on 80 CANVAS patients is reviewed. Results: In addition to the triad of cerebellar impairment, bilateral vestibulopathy and a somatosensory deficit, CANVAS patients may also present with orthostatic hypotension, a chronic cough and neuropathic pain. Management of falls risk and dysphagia is a major clinical priority. Conclusions: CANVAS is an increasingly recognised cause of late-onset ataxia and disequilibrium, and is likely to be a recessive disorder.

Publisher

IOS Press

Subject

Neurology (clinical),Sensory Systems,Otorhinolaryngology,General Neuroscience

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