#Neuro see: [Cameron paeds - acute ataxia](x-devonthink-item://034CBC24-E7A2-48B9-870A-913215235300?page=88) **Causes** - [[Anticholinergic toxicity]] - [[Cranial nerve palsies#CN III palsy|Brainstem CN III palsy]] - [[carbon monoxide]] - [[Altidude illness#High altitude cerebral oedema]] → truncal ataxia - [[hyponatremia|hypo-na]] <130 - [[Hypothermia]] - [[lamotrigine overdose]] - [[​Lithium Toxicity]] >25g acute or mild chronic tox - [[Multiple Sclerosis]] - [[toxic alcohols#Ethylene Glycol]] - [[Valproate]] - [[vertigo#vertebrobasilar insufficiency]], cerebellar haemorrhage, or other posterior stroke syndrome - [[VP shunt]] blockage ## #paeds acute ataxia - postviral : acute cerebellar ataxia (eg after varicella) - tox/poisoning ([[​Lithium Toxicity|lithium]], [[carbon monoxide]], [[toxic alcohols]], [[Iron overdose]], anticonvulsants (esp phenytoin and carbamazepine), eucalyptus oil and tea tree oil - tumours -- posterior fossa - trauma / [[Non-accidental injury|NAI]] - metabolic (↓ Na, ↓ glucose, ↑ ammonia - infection - [[Meningitis]] or encephalitis - cerebral abscess - [[Malaria]] - labyrinthitis - vascular -- stroke, vasculitis - immune -- multiple sclerosis, ADEM **Acute cerebellar ataxia** is most common dx in acute ataxia in children - age 2-7 years - dx of exclusion after considering more sinister causes - often post varicella, EBV, myocoplasm, parvo B19 - prodrome of illness +/- exanthem 5-10 days prior to onset of acute ataxia - varicella vaccination protective - CTB and MRI is normal - CSF may have slight increase cell count and protein *symptoms*: - sudden onset of severe gait ataxia - dysarthria - mild horizontal nystagmus 50% cases - NO focal neurological signs (different from ADEM and MS) # Evaluation ## history ## exam - cerebellar signs - dysmetria and intention tremor - finger-nose / dysdiadokinesis - gait -- ?wide-based, staggering, refusing to walk - vibration sense ## investigations