Ataxia (peds): Difference between revisions
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==Background== | |||
*any disturbance in coordination of movement | *any disturbance in coordination of movement | ||
*most cases in ED | *most cases in ED will be acute (<72h), but can also be episodic or chronic | ||
*etiology usually benign in previously healthy child | *etiology usually benign in previously healthy child | ||
*most cases will be postinfectious cerebellitis, drug ingestion, or | *most cases will be postinfectious cerebellitis, drug ingestion, or [[Guillain Barre]] | ||
==Clinical Features== | |||
*unsteady gait in all cases | *unsteady gait in all cases | ||
*postinfectious cerebellitis | *postinfectious cerebellitis 1-3 wks post URI like illness or immunization, truncal ataxia and gait instability, normal mental status, normal vitals, ONLY ataxia | ||
* | *[[Guillain Barre]] extremity ataxia more than truncal ataxia, areflexia or hyporeflexia, respiratory failure possible | ||
*drug ingestion | *drug ingestion altered mental status, eye findings (nystagmus) | ||
*intracranial mass | *intracranial mass headache, vomiting, gradual onset, visual changes, papilledema, focal neuro deficits | ||
* | *[[Meningitis]]/[[Encephalitis]] fever, meningismus, bulging fontanelle, rash, altered mental status, seizure | ||
==DDx== | |||
*postinfectious cerebellitis (acute cerebellar ataxia) | *postinfectious cerebellitis (acute cerebellar ataxia) | ||
*drug ingestion/ toxin exposure (anticonvulsants, antihistamines, benzos, alcohol, dextromethorphan, others) | *drug ingestion/ toxin exposure (anticonvulsants, antihistamines, benzos, alcohol, dextromethorphan, others) | ||
*Guillain Barre syndrome | *[[Guillain Barre]] syndrome | ||
* | *[[Hypoglycemia]] | ||
*post vaccination (varicella) | *post vaccination (varicella) | ||
* | *[[Encephalitis]]/[[Meningitis]] | ||
*intracranial mass lesion | *intracranial mass lesion | ||
*hydrocephalus | *hydrocephalus | ||
* | *[[Intracranial Bleed]] | ||
* | *[[Stroke]] | ||
*vertebrobasilar dissection | *vertebrobasilar dissection | ||
*migraine | *migraine | ||
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*epilepsy | *epilepsy | ||
==Workup== | |||
*exam | *exam | ||
*tox screen, alcohol level | *tox screen, alcohol level | ||
*accuchek | *accuchek | ||
*drug levels as indicated (ex. antiepileptic level if possible ingestion) | *drug levels as indicated (ex. antiepileptic level if possible ingestion) | ||
* | *[[Head CT]] if concern for trauma or mass lesion | ||
* | *[[Lumbar Puncture]] in most cases unless etiology is known | ||
*EEG if poss | *EEG if poss [[Seizure|seizure]] related | ||
==Treatment== | |||
*most postinfectious cerebellitis self limited, resolve within 3 months without sequelae | *most postinfectious cerebellitis self limited, resolve within 3 months without sequelae | ||
*tox ingestion: supportive. social work or DCFS as indicated | *tox ingestion: supportive. social work or DCFS as indicated | ||
* | *[[Guillain Barre]] admit for IVIG, observation of respiratory status | ||
* | *[[Meningitis]]/[[Encephalitis]] admit, IV abx, see meningitis section | ||
*intracranial mass: | *intracranial mass: neurosurgery consultation | ||
==Disposition== | |||
*consider d/c | *consider d/c home mildly symptomatic, well appearing child with hx and exam c/w postinfectious cerebellitis with excellent follow-up (give injury prevention precautions) | ||
*otherwise, admission indicated for further workup, observation | *otherwise, admission indicated for further workup, observation | ||
==Source== | |||
Harwood-Nuss | Harwood-Nuss | ||
[[Category:Peds]] | [[Category:Peds]] | ||
[[Category:Neuro]] | [[Category:Neuro]] | ||
Revision as of 06:46, 18 December 2013
Background
- any disturbance in coordination of movement
- most cases in ED will be acute (<72h), but can also be episodic or chronic
- etiology usually benign in previously healthy child
- most cases will be postinfectious cerebellitis, drug ingestion, or Guillain Barre
Clinical Features
- unsteady gait in all cases
- postinfectious cerebellitis 1-3 wks post URI like illness or immunization, truncal ataxia and gait instability, normal mental status, normal vitals, ONLY ataxia
- Guillain Barre extremity ataxia more than truncal ataxia, areflexia or hyporeflexia, respiratory failure possible
- drug ingestion altered mental status, eye findings (nystagmus)
- intracranial mass headache, vomiting, gradual onset, visual changes, papilledema, focal neuro deficits
- Meningitis/Encephalitis fever, meningismus, bulging fontanelle, rash, altered mental status, seizure
DDx
- postinfectious cerebellitis (acute cerebellar ataxia)
- drug ingestion/ toxin exposure (anticonvulsants, antihistamines, benzos, alcohol, dextromethorphan, others)
- Guillain Barre syndrome
- Hypoglycemia
- post vaccination (varicella)
- Encephalitis/Meningitis
- intracranial mass lesion
- hydrocephalus
- Intracranial Bleed
- Stroke
- vertebrobasilar dissection
- migraine
- vasculitis
- paraneoplastic syndrome
- epilepsy
Workup
- exam
- tox screen, alcohol level
- accuchek
- drug levels as indicated (ex. antiepileptic level if possible ingestion)
- Head CT if concern for trauma or mass lesion
- Lumbar Puncture in most cases unless etiology is known
- EEG if poss seizure related
Treatment
- most postinfectious cerebellitis self limited, resolve within 3 months without sequelae
- tox ingestion: supportive. social work or DCFS as indicated
- Guillain Barre admit for IVIG, observation of respiratory status
- Meningitis/Encephalitis admit, IV abx, see meningitis section
- intracranial mass: neurosurgery consultation
Disposition
- consider d/c home mildly symptomatic, well appearing child with hx and exam c/w postinfectious cerebellitis with excellent follow-up (give injury prevention precautions)
- otherwise, admission indicated for further workup, observation
Source
Harwood-Nuss