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 will be acute (<72h), but can also be episodic or chronic | *most cases in ED will be acute (<72h), but can also be episodic or chronic | ||
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*most cases will be postinfectious cerebellitis, drug ingestion, or guillain barre | *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: 1-3 wks post URI like illness or immunization, truncal ataxia and gait instability, normal mental status, normal vitals, ONLY ataxia | *postinfectious cerebellitis: 1-3 wks post URI like illness or immunization, truncal ataxia and gait instability, normal mental status, normal vitals, ONLY ataxia | ||
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*meningitis/encephalitis: fever, meningismus, bulging fontanelle, rash, altered mental status, seizure | *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) | ||
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*epilepsy | *epilepsy | ||
===Workup=== | |||
*exam | *exam | ||
*tox screen, alcohol level | *tox screen, alcohol level | ||
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*EEG if poss sz related | *EEG if poss sz 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 | ||
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*intracranial mass: NSG consultation | *intracranial mass: NSG 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) | *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]] | ||
Revision as of 07:10, 4 September 2012
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
- LP in most cases unless etiology is known
- EEG if poss sz 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: NSG 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