Ataxia Michael Babcock Summer 2013. Pediatric Neurology Quick Talks. Scenario. 2 yo girl Acute onset of not walking – every since waking this morning Crying and trying to be carried No fever No recent witnessed trauma No erythema, no pain with palpation of extremities
-Pt can stand with feet together with eyes open, but not eyes closed.
-Pt can not stand with feet together even with eyes open.
-Positive romberg – imbalance with eyes closed
-Testing for sensory ataxia.
Benign paroxysmal vertigo
Inborn Error of Metabolism
Congenital anomaly of posterior fossa
Dandy-walker, chiari, cerebellar dysplasias
Freidrich ataxia, ataxia-telangectasia, Roussy-Levy, spinocerebellar ataxia, episodic ataxias
abetaliproteinemia, vitamin E deficiency, Refsum, Niemann-Pick,Causes of ataxia
A. Intravenous steroids significantly reduce recurrence risk
B. Neuroblastoma is a common cause of these symptoms
C. Repeat lumbar puncture is needed in 2 days
D. Symptoms may resolve in weeks to months
E. Symptoms usually resolve after antibiotic treatmentPREP Question
A 4 year old boy presents to the emergency department with balance problems. He had been previously healthy, but his walking has worsened progressively for the past 2 days, with staggering and lurching.
On PE, the boy is cooperative and alert. His muscles are not tender, and his joints are not red, swollen or tender. His vision seems functionally normal, but there is end-gaze nystagmus in all directions. When sitting independently, his head and trunk bob. His strength appears normal, and his reflexes are normal. When asked to stand with his hands outstretched, a symmetric tremor is evident, and worsens as he approaches this target on finger-to-nose testing. His gait is broad-based. A urine toxicology screen reveals normal results. Brain magnetic resonance imaging shows no tumors or other gray or white matter lesions. Lumbar puncture shows 3 WBCs, 2 RBCs, protein 20, glucose 50.
-Cerebellar findings on exam: Lateral end gaze nystagmus, dysmetria, ataxia, titubation.
-Subacute onset with normal mental status suggests acute cerebellar ataxia
-Usually acquired after infection or immunization
-MRI shows lesion
-Regarding other choices:
A. Intravenous steroids significantly reduce recurrence risk: They don\'t
B. Neuroblastoma is a common cause of these symptoms: not as common
C. Repeat lumbar puncture is needed in 2 days: no new information
E. Symptoms usually resolve after antibiotic treatment: Not a primary infectious process
-maria, b. current management in child neurology.2009