Acute Ataxia in Children.

Abstract

1. Philip Overby, MD, MA*,† 2. Matthew Kapklein, MD† 3. Ronald I. Jacobson, MD*,† 1. *Department of Neurology and 2. †Department of Pediatrics, New York Medical College, Valhalla, NY * Abbreviations: ACA: : acute cerebellar ataxia ADEM: : acute disseminated encephalomyelitis CSF: : cerebrospinal fluid CT: : computed tomographic GBS: : Guillain-Barre syndrome ICH: : intracerebral hemorrhage ICP: : intracranial pressure IV: : intravenous IVIg: : intravenous immunoglobulin MRI: : magnetic resonance imaging NMDA: : N -methyl-d-aspartate OMS: : opsoclonus-myoclonus syndrome TM: : transverse myelitis tPA: : tissue plasminogen activator WBC: : white blood cell The word ataxia in medicine frequently is used to signify not only difficulty walking but also difficulty walking specifically due to cerebellar dysfunction. However, although gait and cerebellar disorders can overlap, they are not synonymous. The purpose of this review is to illustrate how children with difficulty walking present, which includes, but is not limited to, patients with cerebellar disorders. In addition, the goal is to illustrate both the more common and the more urgent causes of acute ataxia in children. After completing this article, readers should be able to: 1. Recognize the most common and the most urgent causes of acute ataxia in children. 2. Recognize that ataxia is a nonlocalizing complaint, frequently misinterpreted as being localized entirely to the cerebellum. 3. Take the first steps in the evaluation and management of acute ataxia. Acute ataxia is fairly common in children. The most common cause, acute cerebellar ataxia (ACA), is estimated to occur in 1 in 100,000 children. (5) The causes of acute ataxia in children are typically benign but at times can represent serious illness. The comprehensive range of potential causes is broad, but typical causes are few and have changed in the post–varicella vaccine era. Ataxia is also frequently thought to represent cerebellar disease but can, in fact, be due to dysfunction of any part of the nervous system or occasionally nonneurologic mechanisms. This paper reviews the common causes of acute ataxia in children, as well as less common causes that should not be missed. It attempts to aid the reader in approaching the neurologic examination, as well as the first steps in the management of the ataxic child. …