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 

Differential Diagnosis

Evaluation

  • exam
  • 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

See Also

References