Ataxia (peds): Difference between revisions
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*[[Utox|tox screen]], alcohol level | *[[Utox|tox screen]], alcohol level | ||
*fingerstick glucose | *fingerstick glucose | ||
*drug levels as indicated (ex. [[antiepileptic]] level if possible ingestion) | *drug levels as indicated (ex. [[anticonvulsants|antiepileptic]] level if possible ingestion) | ||
*[[Head CT]] if concern for trauma or mass lesion | *[[Head CT]] if concern for trauma or mass lesion | ||
*[[Lumbar Puncture]] in most cases unless etiology is known | *[[Lumbar Puncture]] in most cases unless etiology is known | ||
Revision as of 23:34, 1 October 2019
For adult patients see ataxia
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 weeks 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
- Systemic conditions
- Intoxications with diminished alertness
- Intoxications with relatively preserved alertness
- Other metabolic disorders
- Disorders predominantly of the nervous system
- Conditions affecting predominantly one region of the CNS
- Hemorrhage, vertebral and carotid artery dissection
- Infarction
- Lateral medullary syndrome
- Degenerative changes
- Abscess
- Brain tumor
- Head trauma
- Hydrocephalus, normal pressure hydrocephalus, VP shunt malfunction
- Parkinson's disease
- Prion disease
- Heat stroke
- Leukostasis and hyperleukocytosis
- Cervical spondylosis
- Posterior column disorders
- Conditions affecting predominantly the peripheral nervous system
- Peripheral neuropathy
- Vestibulopathy (e.g. vestibular neuritis, labyrinthitis)
- Guillain-Barre
- Miscellaneous
- Acute mountain sickness
- Syphilis
- Tick paralysis
- Ciguatera, neurotoxic shellfish poisoning
- African trypanosomiasis
- Tympanic membrane rupture
- Legionella
- Paraneoplastic syndromes
- Postinfectious cerebellitis (acute cerebellar ataxia)
- Post vaccination (varicella)
- Vasculitis
- Epilepsy
- Conditions affecting predominantly one region of the CNS
Evaluation
- 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