Ataxia (peds): Difference between revisions

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{{Peds top}} [[ataxia]]
==Background==
==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  
*etiology usually benign in previously healthy child  
*Etiology usually benign in previously healthy child  
*most cases will be postinfectious cerebellitis, drug ingestion, or [[Guillain Barre]]
*Most cases will be postinfectious cerebellitis, drug ingestion, or [[Guillain Barre]]


==Clinical Features==
==Clinical Features==
*unsteady gait in all cases  
*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  
*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)  
*Drug ingestion: [[altered mental status]], eye findings ([[nystagmus]])  
*intracranial mass: [[headache]], [[vomiting]], gradual onset, visual changes, papilledema, focal neuro deficits  
*[[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]]&nbsp;
*[[Meningitis]]/[[Encephalitis]] [[fever]], meningismus, [[bulging fontanelle]], [[rash]], [[altered mental status (peds)|altered mental status]], [[seizure (peds)|seizure]]&nbsp;


==Differential Diagnosis==
==Differential Diagnosis==
*Postinfectious cerebellitis (acute cerebellar ataxia)
*Systemic conditions
*Drug ingestion/ toxin exposure ([[antiepileptics]], [[antihistamines]], [[benzos]], [[alcohol]], [[dextromethorphan toxicity|dextromethorphan]], others)
**Intoxications with diminished alertness
*[[Guillain Barre]] syndrome  
***[[Ethanol]]
*[[Hypoglycemia]]  
***[[Sedative/hypnotic toxicity]]
*Post vaccination ([[varicella]])  
***[[Toxic alcohols]]
*[[Encephalitis]]/[[meningitis]]  
***[[GHB]]
*[[Intracranial mass]] lesion
***[[Benzodiazepine toxicity]]
*[[Hydrocephalus]]  
***[[TCA toxicity]]
*[[Intracranial Bleed]]  
***[[Antipsychotic toxicity]]
*[[Stroke]]
***[[Inhalant abuse]], [[hydrocarbon toxicity]]
*Vertebrobasilar dissection
***[[Pentobarbital]]
*[[migraine]]  
***[[Chloral hydrate toxicity]]
*[[Vasculitis]]  
***[[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==
*exam
*[[Utox|tox screen]], alcohol level  
*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  
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*[[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==
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[[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

Differential Diagnosis

Evaluation

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

See Also

References