Episode 199: Ataxia in Children

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

* 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

* 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

* 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

* 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

* 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

* 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

* Diverse Etiologies:  Ataxia in children can have various causes that range from self-limiting to life-threatening
* Comprehensive Assessment: History and physical exams guide diagnosis and workup direction, focusing on symptom time course, infections, and toxic exposures.
* Physical Examination Clues: Vital signs and appearance offer clues; increased ICP may ...