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 — Adult and Pediatric Emergency Medicine
- Senior 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 .
- Friday JH. Ataxia. In: Textbook of Pediatric Medicine, 6th, Fleisher GR, Ludwig SL. (Eds), Lippincott Williams & Wilkins, Philadelphia 2010. p.164.
- Ryan MM, Engle EC. Acute ataxia in childhood. J Child Neurol 2003; 18:309.
- Gieron-Korthals MA, Westberry KR, Emmanuel PJ. Acute childhood ataxia: 10-year experience. J Child Neurol 1994; 9:381.
- Pollack IF. Brain tumors in children. N Engl J Med 1994; 331:1500.
- Ullrich NJ, Pomeroy SL. Pediatric brain tumors. Neurol Clin 2003; 21:897.
- Matthay KK, Blaes F, Hero B, et al. Opsoclonus myoclonus syndrome in neuroblastoma a report from a workshop on the dancing eyes syndrome at the advances in neuroblastoma meeting in Genoa, Italy, 2004. Cancer Lett 2005; 228:275.
- Tate ED, Allison TJ, Pranzatelli MR, Verhulst SJ. Neuroepidemiologic trends in 105 US cases of pediatric opsoclonus-myoclonus syndrome. J Pediatr Oncol Nurs 2005; 22:8.
- Aryan HE, Giannotta SL, Fukushima T, et al. Aneurysms in children: review of 15 years experience. J Clin Neurosci 2006; 13:188.
- Greenes DS. Neurotrauma. In: Textbook of Pediatric Emergency Medicine, 6th, Fleisher GR, Ludwig SL. (Eds), Lippincott Williams & Wilkins, Philadelphia 2010. p.1422.
- Stumpf DA. Acute ataxia. Pediatr Rev 1987; 8:303.
- Fischer EG, McLennan JE, Suzuki Y. Cerebral abscess in children. Am J Dis Child 1981; 135:746.
- Hegde AS, Venkataramana NK, Das BS. Brain abscess in children. Childs Nerv Syst 1986; 2:90.
- Townsend GC. Brain abscess and other focal pyogenic infections. In: Infectious Diseases, 2nd, Cohen J, Powderly WG. (Eds), Mosby, Edinburgh 2004. p.279.
- Mori M, Kuwabara S, Fukutake T, et al. Clinical features and prognosis of Miller Fisher syndrome. Neurology 2001; 56:1104.
- Casselbrant ML, Mandel EM. Balance disorders in children. Neurol Clin 2005; 23:807.
- Tusa RJ. Bedside assessment of the dizzy patient. Neurol Clin 2005; 23:655.
- Pellegrini S, Gonzalez Macchi ME, Sommerfleck PA, Bernáldez PC. Intratemporal complications from acute otitis media in children: 17 cases in two years. Acta Otorrinolaringol Esp 2012; 63:21.
- Bennett HS, Selman JE, Rapin I, Rose A. Nonconvulsive epileptiform activity appearing as ataxia. Am J Dis Child 1982; 136:30.
- Augustine EF, Johnston MV. Movement disorders. In: Nelson Textbook of Pediatrics, 19th, Kliegman RM, Stanton BF, St.Geme, et al. (Eds), Saunders, Philadelphia 2011. p.2053.
- Miyamoto RC, Miyamoto RT. Pediatric neurotology. Semin Pediatr Neurol 2003; 10:298.
- 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