TY - CHAP M1 - Book, Section TI - Ataxia A1 - Fuchs, Susan A2 - Schafermeyer, Robert A2 - Tenenbein, Milton A2 - Macias, Charles G. A2 - Sharieff, Ghazala Q. A2 - Yamamoto, Loren G. PY - 2014 T2 - Strange and Schafermeyer's Pediatric Emergency Medicine, 4e AB - Ataxia can result from a variety of lesions, including damage to the peripheral nerves, spinal cord, cerebellum, and cerebral hemispheres. One of the most common etiologies is drug intoxication, especially with alcohol, benzodiazepines, or phenytoin.Findings of cerebellar dysfunction include nystagmus, staggering, wide-based gait, and titubation. In addition, a sensory examination for light touch and pinprick, position, and vibration sense should be performed because lower-extremity sensory impairment can cause ataxia.In a patient with acute ataxia, the history and physical examination focus on excluding acute infectious etiologies, such as meningitis or encephalitis, lesions that result in increased intracranial pressure, such as hemorrhage and tumors, and toxic ingestions.A common cause of ataxia in children younger than 6 years is acute cerebellar ataxia, a postinfectious phenomenon that often occurs about 2 weeks after a viral illness. The onset of ataxia is insidious and predominantly affects the gait, although dysmetria, nystagmus, and dysarthria can occur.In children, the most common cause of intermittent ataxia is a migraine headache that involves the basilar artery. Besides ataxia, associated symptoms include blurred vision, visual field deficits, vertigo, and headache.Chronic/progressive ataxia has an insidious onset and progresses slowly over weeks to months. The differential diagnosis consists of brain tumors, hydrocephalus, and genetic disorders.The combination of ataxia, headache, irritability, and vomiting in a child younger than 6 years is characteristic of a brain tumor.Hereditary causes of ataxia include spinocerebellar ataxias, of which there are over 30 types. Friedrich's ataxia is common autosomal recessive ataxia, which usually manifests before 10 years of age. It is characterized by ataxia, nystagmus, dysarthria, kyphoscoliosis, cardiomyopathy, and absent deep tendon reflexes.Patients with progressive ataxia require a thorough evaluation in the emergency department (ED). All patients are examined for signs of increased intracranial pressure, which in some cases can be severe enough to result in the threat of uncal herniation. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/10/09 UR - accessemergencymedicine.mhmedical.com/content.aspx?aid=1105682929 ER -