Approach to the child with acute ataxia
- Dewesh Agrawal, MD
Dewesh Agrawal, MD
- Associate Professor of Pediatrics and Emergency Medicine
- Children's National Medical Center
- Section Editors
- Stephen J Teach, MD, MPH
Stephen J Teach, MD, MPH
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics and Emergency Medicine
- George Washington University School of Medicine and Health Sciences
- Marc C Patterson, MD, FRACP
Marc C Patterson, MD, FRACP
- Section Editor — Pediatric Neurology
- Professor of Neurology, Pediatrics, and Medical Genetics
- Chair, Division of Child and Adolescent Neurology
- Mayo Clinic College of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
This topic will review causes and clinical features of acute ataxia in children. Episodic and chronic conditions associated with ataxia will be discussed briefly. An algorithmic approach to the child with acute ataxia is presented.
Ataxia can be defined as a disturbance in the smooth, accurate coordination of movements. It is most commonly manifested as an unsteady gait .
Ataxia is usually the result of cerebellar dysfunction. However, disturbances at many levels of the nervous system can also affect coordination . As an example, ataxia that develops as the result of loss of sensory function (such as proprioception) would be described as a sensory ataxia.
Acute ataxia is an uncommon presenting complaint in children. Although causes of acute ataxia include life-threatening conditions such as mass lesions and central nervous system (CNS) infection, the majority of children have a benign, self-limited process. Historical features, specific physical findings, and selected ancillary studies can identify most causes of ataxia, particularly those that are serious and require stabilization and intervention.
Conditions that cause acute ataxia include acute infections, post-infectious inflammatory conditions, toxins, tumors, and trauma (table 1). In one retrospective series, 80 percent of children with acute ataxia who were evaluated in an emergency department and subsequently hospitalized had a discharge diagnosis of acute cerebellar ataxia, a toxic ingestion, or Guillain-Barré syndrome .
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- Life-threatening conditions
- - Tumors
- - Intracranial hemorrhage
- - Stroke
- - Infection
- Common conditions
- - Acute cerebellar ataxia
- - Guillain-Barré syndrome
- - Labyrinthitis
- - Toxic exposure
- - Migraine syndromes and benign paroxysmal vertigo
- - Trauma
- Other conditions
- Physical examination
- - General examination
- - Neurologic examination
- Ancillary studies
- - Laboratory
- - Imaging
- - Electrophysiologic studies
- ALGORITHMIC APPROACH
- No trauma
- - Life-threatening signs/symptoms
- - No life-threatening signs/symptoms
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS