This document provides guidance on evaluating a child presenting with ataxia. It outlines important questions to ask about the history of present illness, past medical history, family history, and potential causes based on acuity of onset. Investigations are recommended in a stepwise approach starting with bloodwork and other labs, then imaging, with neurology consultation if needed. The goal is to identify potential infectious, toxic, metabolic, structural or hereditary causes of ataxia in children.
This document provides guidance on evaluating a child presenting with ataxia. It outlines important questions to ask about the history of present illness, past medical history, family history, and potential causes based on acuity of onset. Investigations are recommended in a stepwise approach starting with bloodwork and other labs, then imaging, with neurology consultation if needed. The goal is to identify potential infectious, toxic, metabolic, structural or hereditary causes of ataxia in children.
This document provides guidance on evaluating a child presenting with ataxia. It outlines important questions to ask about the history of present illness, past medical history, family history, and potential causes based on acuity of onset. Investigations are recommended in a stepwise approach starting with bloodwork and other labs, then imaging, with neurology consultation if needed. The goal is to identify potential infectious, toxic, metabolic, structural or hereditary causes of ataxia in children.
This document provides guidance on evaluating a child presenting with ataxia. It outlines important questions to ask about the history of present illness, past medical history, family history, and potential causes based on acuity of onset. Investigations are recommended in a stepwise approach starting with bloodwork and other labs, then imaging, with neurology consultation if needed. The goal is to identify potential infectious, toxic, metabolic, structural or hereditary causes of ataxia in children.
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13.
CHILD WITH AN UNSTEADY GAIT
History
When you are faced with a child with ataxia, start with the basics: ABC’s!!! Ensure that your patient is stable and comfortable and then proceed further. In addition to a thorough history, include the following pertinent questions:
HPI: timing, onset, progression (congenital vs insidious vs acute), nature of ataxia, associated symptoms: fever, nausea, vomiting, lethargy, headache, head tilting? HINT: signs of increased ICP: early morning headache, vomiting, change in mental status
o Any previous episodes of ataxia? o Onset: any recent viral infection or cough? o HINT: Varicella is the most common acute infectious cause of ataxia o Any medications, drugs or poisons possibly ingested? o HINT: Are there any visitors taking anticovulsants or antipsychotics? o Any alcohol or other illegal drugs? o Any trauma? o Is there the possibility of a suicide attempt? o Any change in mental status?
PMH: Birth Hx: exposures, TORCHES (congenital infections including
toxoplasmosis, rubella, CMV, Herpes, Syphillis), congenital anomalies (ataxia can be congenital or hereditary, but not appear until later).
Family History: sickle cell, metabolic disease, epilepsy, migraines or Friedrich’s
ataxia.
Another clue to the cause of ataxia, is in its acuity of onset.
Brain Tumors (as above) Benign Parxoysmal Vertigo Basilar Migraine Hereditary Ataxia o Autosomal recessive inheritance Ataxia telangiectasia Friedrich’s Ataxia Hartnup’s disease Hypobetalipoproteinemia Refsum’s disease Wilson’s disease Congenital Malfomations o Basilar impression o Cerebellar aplasia o Dandy Walker Malformation o Vermal apalsia o Chiari malformation Metabolic/Inborn Errors of Metabolism o Maple syrup urine disease o Ornithine transcarbamylase deficiency
PROCEDURES FOR INVESTIGATION
HINT: One approach to working through investigations is to think in this pattern: 1. Blood 2. Other body fluids 3. Imaging and 4. Consults.
Bloodwork: o CBC and differential (infection) o Electrolytes with bicarbonate (imbalances), o Monospot o Toxicology screen (for anticonvulsants, hypnotics and phenothiazines, for alcohol and drugs of abuse; for heavy metals) o Consider metabolic screen and IgA (for ataxia telangiectasia) Urine: toxicology screen Lumbar Puncture: if differential includes meningitis and fundi are normal (ie) don’t cause a tonsillar herniation of the brain due to increased ICP); look for CSF protein if demyelinating disease is suspected. Imaging: Consider CT/ MRI if there are focal neurological findings. Consults: Neurology
