II. Causes
- See Ataxia for causes seen in both adults and children
- Congenital malformations
- Acute Cerebellar Ataxia
- Follows febrile illness by 7-10 days, especially in males (see infections below)
- Autoimmune mediated Cerebellum demyelination
- Maximal findings at onset, most significantly affecting truncal Ataxia
- Presents with normal mental status (contrast with Acute Demyelinating Encephalomyelitis)
- Acute Demyelinating Encephalomyelitis (ADEM, Acute Disseminated Encephalomyelitis)
- Follows infectious illness or Vaccines (or in 26% idiopathic) by days to weeks (see infections below)
- More common in males, and in winter and spring
- Maximal findings at onset, with a Constellation of neurologic symptoms (e.g. Headache, Hemiplegia, Ataxia)
- Presents with acute Altered Level of Consciousness or encephalopathy (coma in some cases)
- Most severe form is acute hemorrhagic leukoencephalomyelitis
- Administer Methylprednisolone 20-30 mg/kg/day (up to 1 gram daily) for 3-5 days, then taper over 4-6 weeks
- Full recovery in >60% of cases with aggressive management (previously mortality was >30%)
- Opsoclonus-myoclonus syndrome
- Paraneoplastic syndrome seen in children under age 3 years old
- Neuroblastoma presentation in 50% of cases (post-viral in others)
- Associated with rapid chaotic eye movements, Myoclonic Jerks, encephalopathy, Vomiting, irritability
III. Causes: Infections and Vaccines
- Viral
- Varicella (most common)
- Influenza
- Epstein-Barr Virus (EBV, Mononucleosis)
- Cytomegalovirus (CMV)
- Coxsachie Virus
- Herpes Simplex Virus
- Human Immunodeficiency Virus (HIV)
- Measles
- Mumps
- Rubella
- Viral Hepatitis
- Rocky Mountain Spotted Fever
-
Bacterial
- Streptococcal species
- Campylobacter
- Legionella
- Mycoplasma
- Chlamydia
- Borrelia
- Immunizations
IV. Evaluation
- See Ataxia
V. References
- Streich and Huff (2015) Crit Dec Emerg Med 29(2): 2-9
- Salas (2010) Emerg Med J 27(12): 956-7 [PubMed]