Ataxia (peds): Difference between revisions
(Text replacement - " wks " to " weeks ") |
No edit summary |
||
(6 intermediate revisions by 2 users not shown) | |||
Line 1: | Line 1: | ||
{{Peds top}} [[ataxia]] | |||
==Background== | ==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== | ==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 | *[[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, [[blurred vision|visual changes]], [[papilledema]], [[focal neuro deficits]] | ||
*[[Meningitis]]/[[Encephalitis]] [[fever]], meningismus, bulging fontanelle, rash, altered mental status, [[seizure]] | *[[Meningitis]]/[[Encephalitis]] [[fever]], meningismus, [[bulging fontanelle]], [[rash]], [[altered mental status (peds)|altered mental status]], [[seizure (peds)|seizure]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
* | *Systemic conditions | ||
* | **Intoxications with diminished alertness | ||
*[[ | ***[[Ethanol]] | ||
*[[ | ***[[Sedative/hypnotic toxicity]] | ||
* | ***[[Toxic alcohols]] | ||
*[[ | ***[[GHB]] | ||
*[[ | ***[[Benzodiazepine toxicity]] | ||
*[[ | ***[[TCA toxicity]] | ||
*[[ | ***[[Antipsychotic toxicity]] | ||
*[[ | ***[[Inhalant abuse]], [[hydrocarbon toxicity]] | ||
* | ***[[Pentobarbital]] | ||
*[[ | ***[[Chloral hydrate toxicity]] | ||
*[[ | ***[[Marijuana toxicity]] | ||
*[[Paraneoplastic syndromes]] | ***[[Phencyclidine toxicity]] | ||
*[[Epilepsy]] | **Intoxications with relatively preserved alertness | ||
***[[phenytoin toxicity|Phenytoin]], [[fosphenytoin]], [[Keppra]] | |||
***[[Carbamazepine toxicity|Carbamazepine]], [[oxcarbazepine]] | |||
***[[Valproic acid toxicity|Valproic acid]] | |||
***[[Heavy metal toxicity|Lead, organic mercurials]] | |||
***[[Carbon monoxide]] | |||
***[[Acute radiation syndrome]] | |||
***[[Lithium toxicity]] | |||
***[[Mushroom toxicity]] | |||
***[[Lacosamide]] | |||
***[[Arsenic toxicity]] | |||
***[[Gabapentin]] | |||
***[[Marijuana toxicity]] | |||
***[[Phencyclidine toxicity]] | |||
***[[Lindane]] | |||
***[[Vitamin A toxicity]] | |||
**Other metabolic disorders | |||
***[[Hyponatremia]] | |||
***[[Hypernatremia]] | |||
***[[Hypomagnesemia]] | |||
***[[Inborn errors of metabolism]] | |||
***[[Wernicke disease]] | |||
***[[Vitamin B7 deficiency]] | |||
***[[Vitamin E deficiency]] | |||
*Disorders predominantly of the nervous system | |||
**Conditions affecting predominantly one region of the CNS | |||
***[[ICH|Hemorrhage]], [[vertebral and carotid artery dissection]] | |||
***[[Stroke|Infarction]] | |||
***[[Lateral medullary syndrome]] | |||
****Degenerative changes | |||
***[[Brain abscess|Abscess]] | |||
***[[Brain tumor]] | |||
***[[Head trauma]] | |||
***[[Hydrocephalus]], [[normal pressure hydrocephalus]], [[VP shunt malfunction]] | |||
***[[Parkinson's disease]] | |||
***[[Prion disease]] | |||
***[[Heat stroke]] | |||
***[[Leukostasis and hyperleukocytosis]] | |||
***Cervical spondylosis | |||
***[[spinal cord injury|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]] | |||
==Evaluation== | ==Evaluation== | ||
* | *[[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 | ||
Line 44: | Line 100: | ||
*[[Guillain Barre]] admit for IVIG, observation of respiratory status | *[[Guillain Barre]] admit for IVIG, observation of respiratory status | ||
*[[Meningitis]]/[[Encephalitis]] admit, IV antibiotic, see meningitis section | *[[Meningitis]]/[[Encephalitis]] admit, IV antibiotic, see meningitis section | ||
*intracranial mass: neurosurgery consultation | *[[intracranial mass]]: neurosurgery consultation | ||
==Disposition== | ==Disposition== | ||
Line 59: | Line 115: | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Neurology]] | [[Category:Neurology]] | ||
[[Category:Symptoms]] |
Latest revision as of 22:50, 28 November 2019
This page is for pediatric patients. 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