Consultation with the Specialist

Abstract

A child or adolescent who has ataxia should stimulate a pediatrician to consider a broad array of possible diagnoses. The incoordination of muscle action can be caused by pathology located anywhere from the cerebral cortex to the involved muscle. Ataxia can be frightening to all involved, and the tendency is to call a neurologist quickly. However, without the information gathered from a careful history and physical examination, unnecessary expensive tests might be ordered and consultation with the neurologist would not be efficient. The Table provides an extensive but not exhaustive list of possible causes of ataxia. However, the omitted diagnoses are extremely rare and most likely would be made only by a subspecialist after an exhaustive evaluation. The most common causes of ataxia generally can be diagnosed and managed by the general pediatrician. They fall in the categories of acute infectious, postinfectious, and metabolic etiologies. The diagnoses that are life-threatening if not diagnosed and treated rapidly must be considered first, and they also fall primarily in the infectious and metabolic categories. These include acute bacterial infections and metabolic aberrations, such as hypoglycemia, hyponatremia, hyperammonemia, and ingestion of alcohol and other drugs and toxins. Neoplasias and vascular problems are less common but also can fall in this category; they generally require management by a subspecialist.