Ataxia (peds)

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

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

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