Acute ataxia in paediatric emergency departments: a multicentre Italian study

Abstract

ObjectivesTo evaluate the causes and management of acute ataxia (AA) in the paediatric emergency setting and to identify clinical features predictive of an underlying clinically urgent neurological pathology (CUNP).Study designThis is a retrospective medical chart analysis of children (1–18 years) attending to 11 paediatric emergency departments (EDs) for AA in an 8-year period. A logistic regression model was applied to identify clinical risk factors for CUNP.Results509 patients (mean age 5.8 years) were included (0.021% of all ED attendances). The most common cause of AA was acute postinfectious cerebellar ataxia (APCA, 33.6%). Brain tumours were the second most common cause (11.2%), followed by migraine-related disorders (9%). Nine out of the 14 variables tested showed an OR >1. Among them, meningeal and focal neurological signs, hyporeflexia and ophthalmoplegia were significantly associated with a higher risk of CUNP (OR=3–7.7, p<0.05). Similarly, the odds of an underlying CUNP were increased by 51% by each day from onset of ataxia (OR=1.5, CI 1.1 to 1.2). Conversely, a history of varicella-zoster virus infection and vertigo resulted in a significantly lower risk of CUNP (OR=0.1 and OR=0.5, respectively; p<0.05).ConclusionsThe most frequent cause of AA is APCA, but CUNPs account for over a third of cases. Focal and meningeal signs, hyporeflexia and ophthalmoplegia, as well as longer duration of symptoms, are the most consistent ‘red flags’ of a severe underlying pathology. Other features with less robust association with CUNP, such as seizures or consciousness impairment, should be seriously taken into account during AA evaluation.

Expanding the Spectrum of Acute Cerebellitis due to SARS-Cov-2

“…The diagnosis of acute cerebellitis rather than postinfectious cerebellar ataxia should be considered when MRI changes are noticeable in the cerebellar cortex and headache accompany ataxia. 2,3 Among the pathogens causing acute cerebellitis, varicella zoster, Epstein-Barr, herpes simplex-1, influenza-A, respiratory syncytial virus, rotavirus, cytomegalovirus, echovirus, coxsackie, mumps, measles, rubella, Mycoplasma pneumoniae and Streptococcus pneumonia are the most common. 2,3 To our knowledge, , SARS-CoV-2 has been associated to acute cerebellitis only in two children, although both featured by severe neurological presentations.…”

Ataksja u dzieci – jak rozpoznać i jak leczyć?

“…Ataksja nie stanowi częstego objawu w populacji pediatrycznej. W wieloośrodkowym, włoskim badaniu [1] spośród pacjentów w wieku 1-18 r.ż. zgłaszających się do pediatrycznej izby przyjęć ataksję zdiagnozowano zaledwie u 0,02% (508) dzieci.…”

“…Wśród pozostałych przyczyn ataksji ostrej wyróżnia się toksyczne działanie leków (przeciwpadaczkowych, przeciwnowotworowych, immunosupresyjnych i benzodiazepin) oraz zatrucia m.in. : alkoholem, rtęcią, talem, litem, toluenem [1].…”

“…Ataksja stanowi ponadto obok oftalmoplegii i arefleksji jeden spośród triady objawów w zespole Millera-Fishera, który jest odmianą zespołu Guillaina-Barrego [1].…”

Clinical Characteristics and Effects of Steroid Therapy in Children with Acute Cerebellar Ataxia

“…However, ACA is known to be the most common cause of childhood ataxia, accounting for 30% to 50% of childhood ataxia cases [5][6][7]. Garone et al [8] reported that the number of patients with acute ataxia as the chief complaint was 0.021% of all patients who visited the emergency room, and 33.6% of patients with acute ataxia were diagnosed with postinfectious ACA, which was the most common cause of acute ataxia.…”