Pediatric emergency medicine trisk 2646 2646
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DISORDERS OF BALANCE (SEE CHAPTERS 15 ACUTE
ATAXIA AND 24 DIZZINESS AND VERTIGO )
Goals of Treatment
Disordered balance has a broad differential diagnosis and is often associated with
symptoms such as nausea, dizziness, vertigo, and ataxia. Ataxia is an inability to
produce smooth, coordinated movements and is typically a sign of cerebellar
dysfunction. Alterations of balance and ataxia can result from dysfunction of the
nervous system at many levels: cerebellum, sensory pathways, posterior columns
of the spinal cord. Ataxia can be a manifestation of motor weakness as seen in
Guillain–Barré. Therefore, early goals of treatment should focus on identifying
the level of nervous system involvement and ruling out life-threatening causes,
intracranial mass lesion, stroke, CNS hemorrhage, CNS infection.
CLINICAL PEARLS AND PITFALLS
Acute ataxia is uncommon but most cases are secondary to a benign
etiology.
Cerebellar dysfunction is the most common cause of ataxia.
Signs of cerebellar dysfunction include the following:
Gait disturbance, truncal ataxia, nystagmus, dysmetria, tremor
MRI is the imaging modality of choice for acute ataxia.
Acute Ataxia
Acute postinfectious cerebellar ataxia (APCA) and intoxication are the two most
common causes of acute ataxia in children. APCA is characterized by the acute
onset of unsteadiness in a previously well child. It is seen primarily between the
ages of 1 and 4 years but can occur at any time during childhood. The exact cause
of the illness is unclear; however, it is believed to be a parainfectious or
postinfectious demyelinating phenomenon and likely represents a localized form
of postinfectious encephalitis. Historically and in regions where varicella is
prevalent, primary varicella is the most common cause of APCA. Other infections
implicated include infectious mononucleosis, enteroviruses, HSV, influenza,
Mycoplasma, and Q fever. Ataxia is usually seen 5 to 10 days after the onset of
illness, although symptoms may be delayed for up to 3 weeks.
