Ataxia (peds)
Revision as of 14:15, 22 March 2016 by Ostermayer (talk | contribs) (Text replacement - "Category:Neuro" to "Category:Neurology")
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
Differential Diagnosis
- 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
Diagnosis
- 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
- Lumbar Puncture in most cases unless etiology is known
- EEG if poss seizure 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: neurosurgery 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