We discuss a case of ataxia in children and how to approach the evaluation of these pts.

Hosts:

Ellen Duncan, MD, PhD

Brian Gilberti, MD

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Ataxia_in_Children.mp3



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Tags: Neurology, Pediatrics





Show Notes

Introduction

• 
  
• The episode focuses on ataxia in children, which can range from self-limiting to life-threatening conditions.
  
• Pediatric emergency medicine specialist shares insights on the topic.
  

The Case

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• An 18-month-old boy presented with ataxia, unable to keep his head up, sit, or stand, and began vomiting.
  
• Previously healthy except for recurrent otitis media and viral-induced wheezing.
  
• The decision to take the child to the emergency department (ED) was based on acute symptoms.
  

Differential Diagnosis

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• Common causes include acute cerebellar ataxia, drug ingestion, Guillain-Barre syndrome, and basilar migraine.
  
• Less common causes include cerebellitis, encephalitis, brain tumors, and labyrinthitis.
  

Importance of History and Physical Examination

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• A detailed history and physical exam are essential in diagnosing ataxia.
  
• Key factors include time course, recent infections, signs of increased intracranial pressure, and toxic exposures.
  
• Look for signs such as bradycardia, hypertension, vomiting, and overall appearance.
  

Diagnostic Workup

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• Initial tests include point-of-care glucose and neuroimaging for concerns about trauma or increased intracranial pressure.
  
• MRI is preferred for posterior fossa abnormalities, but non-contrast head CT is commonly used due to accessibility.
  
• Lumbar puncture may be needed if meningismus is present.
  

Treatment Approach

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• Treatment depends on the underlying cause:
  
  • 
    
  • Acute cerebellar ataxia is self-limiting and typically resolves with time.
    
  • Antibiotics are required for meningitis or encephalitis.
    
  • Steroids may be useful for cerebellitis and acute disseminated encephalomyelitis (ADEM).
    
  • Specialist consultations are necessary for severe diagnoses like intracranial masses.
    
  
  
  

Outcome of the Case Study

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• The child had a normal fast T2 MRI and improved during the ED stay.
  
• Diagnosed with a combination of cerebellar ataxia and labyrinthitis.
  
• Received myringotomy tubes and experienced no further neurologic changes or otitis media episodes.
  

Take-Home Points

1. 
   
2. Diverse Etiologies:  Ataxia in children can have various causes that range from self-limiting to life-threatening
   
3. Comprehensive Assessment: History and physical exams guide diagnosis and workup direction, focusing on symptom time course, infections, and toxic exposures.
   
4. Physical Examination Clues: Vital signs and appearance offer clues; increased ICP may present with bradycardia, hypertension, and vomiting.
   
5. Diagnostic Imaging: Point-of-care glucose testing and neuroimaging are key; MRI is preferred for posterior fossa abnormalities.
   
6. Tailored Treatment: Treatment varies by cause; acute cerebellar ataxia typically resolves over time without specific intervention.
   

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