Acute Ataxia

Matthew Rubach MD
Morning Report
April 16, 2010
Etiology of Acute Ataxia
 Postinfectious: Acute Cerebellar Ataxia
(~40%), ADEM
 Infectious: brainstem encephalitis,
systemic infection
 Toxin: AEDs, benzos, antihistamines
 Mass Lesion
 Acute hydrocephalus
Etiology of Acute Ataxia
 Trauma: cerebellar contusion
 Stroke: vertebral artery dissection
 Paraneoplastic: neuroblastoma &
ganglioneuroblastoma (others, too)
 Sensory ataxia: GBS, Miller-Fisher
variant
 Basilar migraine
 Post-ictal (Todd’s paralysis)
Acute Ataxia in Childhood
 History: fever, rash, GI sx’s, HA, vomiting,
recent vax, head/neck trauma, ingestion

 Exam: AMS, irritability, speech output,

papilledema, limb tone, strength, DTRs

 Diagnostics: Tox screen, Imaging, CSF, EEG,

Electromyography
Meningitis Review
Bacterial Viral Tubercular Cryptococcal

Opening Pressure 200-500 <250 180-300 > 200

WBC 1000-5000 50-1000 50-300 20-50
Differential PMN Lymph Lymph Lymph
Glucose < 40 > 45 > 45 < 40
Protein 100-500 <200 50-300 75
Gram Stain 60-90% + Negative Negative Negative
AFB Negative Negative + in 25% Negative
India Ink 60%

Cryptococcal Ag > 85%

Culture 70-85% 25-86% > 95%

ACP Medicine
Works Cited
Acute ataxia in childhood. J Child Neurol 2003;18:309

Postinfectious acute cerebellar ataxia in children. Clin Pediatr 2003;42:581

Movement Disorders. Nelson’s Pediatrics (18th Ed.), Chapter 597

Meningitis and Encephalitis (chapter). Current Management in Child Neurology (3 rd

Ed.) (Author James Bale Jr., MD)

Acute cerebellar ataxia. Up To Date.

Enterovirus. Nelson’s Pediatrics (18th Ed.), Chapter 247.

Acute Cerebellar Ataxia
• Post-infectious immunologic response
• MC: varicella, coxsackie, echovirus
• CSF normal or mild pleiocytosis
• Distinct from ADEM
• Improves over 2 weeks – 2 months