A separate pediatric ED study retrospectively identified 88 patients aged 1 to 18 years with ataxia over a three year period.⁵ The authors included children with ataxic symptoms less than 30 days and divided the patients into two groups: clinically urgent neurological pathology (CUNP; n=37) and patients who were not clinically urgent (No CUNP; n=51). Children with previously-known diseases associated with ataxia were excluded. Clinically urgent neurological pathology (CUNP) was defined as any nervous system disorder requiring early diagnosis and prompt medical or surgical treatment such as neoplastic, cerebrovascular, and infectious central nervous system disorders, demyelinating disease, acute neuropathies, and CNS malformations. The median age was 5 years and the majority of patients (58 percent) were categorized in the “No CUNP” group which included post-infectious/parainfectious cerebellitis (i.e., post-infectious cerebellar ataxia). The most common overall cause of ataxia, again, was post-infectious/parainfectious cerebellitis (45.5 percent), followed by acute cerebellitis (10.2 percent), and Guillain-Barre (9 percent). While other urgent causes of ataxia within the CUNP group included things like encephalomyelitis, stroke, tumors, and AV malformations, these were uncommon and the authors make little mention of the duration of ataxia and the association with clinically urgent pathology—compared to non-urgent pathology.

Summary

The most common cause of acute ataxia in children is post-infectious cerebellar ataxia and accounts for approximately half of the cases of acute ataxia.

Dr. Jones is associate professor at the department of emergency medicine & pediatrics and the program director of pediatric emergency medicine fellowship at the University of Kentucky in Lexington, Kentucky.

Dr. Cantor is the emeritus medical director for the Central New York Poison Control Center and professor of emergency medicine and pediatrics in Syracuse, New York.

References

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