Ataxia (peds): Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
* | *Postinfectious cerebellitis (acute cerebellar ataxia) | ||
* | *Drug ingestion/ toxin exposure ([[antiepileptics]], [[antihistamines]], [[benzos]], [[alcohol]], [[dextromethorphan toxicity|dextromethorphan]], others) | ||
*[[Guillain Barre]] syndrome | *[[Guillain Barre]] syndrome | ||
*[[Hypoglycemia]] | *[[Hypoglycemia]] | ||
* | *Post vaccination ([[varicella]]) | ||
*[[Encephalitis]]/[[ | *[[Encephalitis]]/[[meningitis]] | ||
* | *[[Intracranial mass]] lesion | ||
*[[ | *[[Hydrocephalus]] | ||
*[[Intracranial Bleed]] | *[[Intracranial Bleed]] | ||
*[[Stroke]] | *[[Stroke]] | ||
* | *Vertebrobasilar dissection | ||
*[[migraine]] | *[[migraine]] | ||
* | *[[Vasculitis]] | ||
* | *[[Paraneoplastic syndromes]] | ||
*[[ | *[[Epilepsy]] | ||
==Evaluation== | ==Evaluation== | ||
Revision as of 01:36, 27 January 2019
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
Differential Diagnosis
- Postinfectious cerebellitis (acute cerebellar ataxia)
- Drug ingestion/ toxin exposure (antiepileptics, 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 syndromes
- Epilepsy
Evaluation
- exam
- tox screen, alcohol level
- fingerstick glucose
- 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 possibly seizure related
Management
- 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 antibiotic, see meningitis section
- intracranial mass: neurosurgery consultation
Disposition
- consider discharge home mildly symptomatic, well appearing child with history and exam consistent with postinfectious cerebellitis with excellent follow-up (give injury prevention precautions)
- otherwise, admission indicated for further workup, observation