Diferencia entre revisiones de «Ataxia (peds)»
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
*postinfectious cerebellitis (acute cerebellar ataxia) | *postinfectious cerebellitis (acute cerebellar ataxia) | ||
*drug ingestion/ toxin exposure ( | *drug ingestion/ toxin exposure ([[antiepileptics]], [[antihistamines]], [[benzos]], [[alcohol]], dextromethorphan, others) | ||
*[[Guillain Barre]] syndrome | *[[Guillain Barre]] syndrome | ||
*[[Hypoglycemia]] | *[[Hypoglycemia]] | ||
| Línea 21: | Línea 21: | ||
*[[Encephalitis]]/[[Meningitis]] | *[[Encephalitis]]/[[Meningitis]] | ||
*intracranial mass lesion | *intracranial mass lesion | ||
*hydrocephalus | *[[hydrocephalus]] | ||
*[[Intracranial Bleed]] | *[[Intracranial Bleed]] | ||
*[[Stroke]] | *[[Stroke]] | ||
*vertebrobasilar dissection | *vertebrobasilar dissection | ||
*migraine | *[[migraine]] | ||
*vasculitis | *vasculitis | ||
*paraneoplastic syndrome | *paraneoplastic syndrome | ||
*epilepsy | *[[epilepsy]] | ||
==Diagnosis== | ==Diagnosis== | ||
Revisión del 23:44 13 jul 2016
Background
- any disturbance in coordination of movement
- most cases in ED will be acute (<72h), but can also be episodic or chronic
- etiology usually benign in previously healthy child
- most cases will be postinfectious cerebellitis, drug ingestion, or Guillain Barre
Clinical Features
- unsteady gait in all cases
- postinfectious cerebellitis: 1-3 wks post URI like illness or immunization, truncal ataxia and gait instability, normal mental status, normal vitals, ONLY ataxia
- Guillain Barre extremity ataxia more than truncal ataxia, areflexia or hyporeflexia, respiratory failure possible
- drug ingestion: altered mental status, eye findings (nystagmus)
- intracranial mass: headache, vomiting, gradual onset, visual changes, papilledema, focal neuro deficits
- Meningitis/Encephalitis fever, meningismus, bulging fontanelle, rash, altered mental status, seizure
Differential Diagnosis
- postinfectious cerebellitis (acute cerebellar ataxia)
- drug ingestion/ toxin exposure (antiepileptics, antihistamines, benzos, alcohol, dextromethorphan, others)
- Guillain Barre syndrome
- Hypoglycemia
- post vaccination (varicella)
- Encephalitis/Meningitis
- intracranial mass lesion
- hydrocephalus
- Intracranial Bleed
- Stroke
- vertebrobasilar dissection
- migraine
- vasculitis
- paraneoplastic syndrome
- epilepsy
Diagnosis
- exam
- tox screen, alcohol level
- accuchek
- drug levels as indicated (ex. antiepileptic level if possible ingestion)
- Head CT if concern for trauma or mass lesion
- Lumbar Puncture in most cases unless etiology is known
- EEG if poss seizure related
Management
- most postinfectious cerebellitis self limited, resolve within 3 months without sequelae
- tox ingestion: supportive. social work or DCFS as indicated
- Guillain Barre admit for IVIG, observation of respiratory status
- Meningitis/Encephalitis admit, IV abx, see meningitis section
- intracranial mass: neurosurgery consultation
Disposition
- consider discharge home mildly symptomatic, well appearing child with hx and exam c/w postinfectious cerebellitis with excellent follow-up (give injury prevention precautions)
- otherwise, admission indicated for further workup, observation