Core EM - Emergency Medicine Podcast

Episode 199: Ataxia in Children

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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

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

                    6. Read More
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