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Monzani NA, Corsello A, Tagliabue C, Pinzani R, Mauri E, Agostoni C, Milani GP, Dilena R. Early acute cerebellar ataxia after meningococcal B vaccine: a case report of a 7-month-old infant and a review of the literature. Ital J Pediatr 2023; 49:61. [PMID: 37277843 DOI: 10.1186/s13052-023-01480-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/26/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Acute cerebellar ataxia (ACA) and acute cerebellitis represent disorders characterized by a para-infectious, post-infectious, or post-vaccination cerebellar inflammation. They are relatively common neurologic disorders among children, and may follow infections, or, more rarely, vaccinations. Few cases are instead described among infants. Although the immunization with meningococcal group B (MenB) vaccine has been associated with some neurological side effects, suspected ACA has been reported only once in the literature. CASE PRESENTATION we describe a 7-month-old female that presented ACA within 24 h from the MenB second dose vaccination. Extensive laboratory studies and magnetic resonance imaging excluded other causes. We then conducted an extended review of other vaccine related cases reported in the literature, focusing on the clinical characteristics of ACA and finding that ataxia and cerebellitis of para- or post-infectious cause are very rarely described in the first year of life. We collected 20 articles published in the last 30 years, including an amount of 1663 patients (1-24 years) with ACA. CONCLUSIONS a very small number of suspected post-vaccinal ataxias has been described in recent years, compared to other causes, and vaccination remains an unquestionable medical need. Further research is needed to clarify the complex pathogenesis of this disorder and its eventual link with vaccinations.
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Affiliation(s)
- Nicola Adriano Monzani
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Milan, Italy
| | - Antonio Corsello
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Claudia Tagliabue
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, SC Pediatria Pneumoinfettivologia, Milan, Italy
| | - Raffaella Pinzani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, SC Pediatria Pneumoinfettivologia, Milan, Italy
| | - Eleonora Mauri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, S.C. Neurofisiopatologia, Milan, Italy
| | - Carlo Agostoni
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Unit, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Gregorio Paolo Milani
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Unit, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Robertino Dilena
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, S.C. Neurofisiopatologia, Milan, Italy.
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Clinical and Brain Imaging Findings of Children with Acute Ataxia: Ten Years of Experience at a Major Pediatric Referral Center. IRANIAN JOURNAL OF RADIOLOGY 2022. [DOI: 10.5812/iranjradiol-132950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Ataxia is a symptom of a wide range of disorders, which manifests as a lack of coordinated movements. It is commonly associated with cerebellar disorders. Objectives: To evaluate the neuroimaging findings of children with acute ataxia (AA) and to identify the association between these findings and clinical results. Patients and Methods: This cross-sectional study was conducted using the electronic medical records of patients, presenting to a major pediatric referral center over 10 years from March 2009 to February 2020. Patients were included in the study if they were younger than 18 years, were diagnosed with AA (< 30 days), and underwent magnetic resonance imaging (MRI), computed tomography (CT) scan, or both. The exclusion criteria were as follows: A history of neurological or medical disorders, explaining ataxia; pseudo-ataxia; a traumatic brain injury; severe loss of consciousness; and missing key information in the medical records (e.g., no brain imaging findings). Patient data, including the demographic data, clinical history, laboratory findings, imaging results, and in-hospital outcomes, were collected. A P-value less than 0.05 was considered statistically significant, and the confidence interval was set at 95%. Results: A total of 119 patients were included in this study (51% female; mean age, 4.9 years). Clinically urgent neurological pathology (CUNP) was detected in 37 (31.09%) patients. The most common pathologies on images were tumors, acute disseminated encephalomyelitis (ADEM), and stroke. However, the most common diagnosis was acute post-infectious cerebellar ataxia (APCA) (24.4%), followed by brain tumors (16.8%) and Guillain-Barre syndrome (GBS) (15.1%), respectively. Overall, 11 variables were significantly different between patients with and without CUNP. Most notably, the duration of symptoms (P < 0.01), ophthalmoplegia (odds ratio [OR] = 13.93; 95% confidence interval [CI]: 3.5 - 54.7), focal neurologic deficit (OR = 7.26; 95% CI: 2.6 - 20.5), and fever (OR = 3.33; 95% CI: 1.1 - 9.8) were associated with a higher risk of CUNP. On the other hand, some features, such as a recent history of febrile illness (presence of fever or body temperature above 38°C in the last month) (OR = 0.36; 95% CI: 0.16 - 0.8) and hyporeflexia (P < 0.01), were associated with a lower risk of CUNP. Conclusion: Acute post-infectious cerebellar ataxia was the most common diagnosis of AA in children, undergoing neuroimaging studies in our center. Nevertheless, tumor was the most common pathology detected on the images of patients with CUNP. Some pathologies might not be detected by some imaging modalities. Considering the associations identified in this study, patients with risk factors, such as a longer duration of symptoms, ophthalmoplegia, focal neurologic deficit, and fever, need to undergo another imaging modality with higher sensitivity if there are no positive findings in the initial imaging study. On the other hand, patients with protective factors, such as hyporeflexia and a recent history of febrile illness, could benefit more from other diagnostic modalities.
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Radhakrishnan R, Shea LAG, Pruthi S, Silvera VM, Bosemani T, Desai NK, Gilbert DL, Glenn OA, Guimaraes CV, Ho ML, Lam HFS, Maheshwari M, Mirsky DM, Nadel HR, Partap S, Schooler GR, Udayasankar UK, Whitehead MT, Wright JN, Rigsby CK. ACR Appropriateness Criteria® Ataxia-Child. J Am Coll Radiol 2022; 19:S240-S255. [PMID: 36436955 DOI: 10.1016/j.jacr.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 09/07/2022] [Indexed: 11/27/2022]
Abstract
Childhood ataxia may be due to multifactorial causes of impairment in the coordination of movement and balance. Acutely presenting ataxia in children may be due to infectious, inflammatory, toxic, ischemic, or traumatic etiology. Intermittent or episodic ataxia in children may be manifestations of migraine, benign positional vertigo, or intermittent metabolic disorders. Nonprogressive childhood ataxia suggests a congenital brain malformation or early prenatal or perinatal brain injury, and progressive childhood ataxia indicates inherited causes or acquired posterior fossa lesions that result in gradual cerebellar dysfunction. CT and MRI of the central nervous system are the usual modalities used in imaging children presenting with ataxia, based on the clinical presentation. This document provides initial imaging guidelines for a child presenting with acute ataxia with or without a history of recent trauma, recurrent ataxia with interval normal neurological examination, chronic progressive ataxia, and chronic nonprogressive ataxia. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Rupa Radhakrishnan
- Associate Division Chief, Neuroradiology, Indiana University Health, Indianapolis, Indiana.
| | - Lindsey A G Shea
- Research Author, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sumit Pruthi
- Panel Chair, Vanderbilt Children's Hospital, Nashville, Tennessee
| | | | | | | | - Donald L Gilbert
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; American Academy of Neurology
| | - Orit A Glenn
- Director, Pediatric Neuroradiology, University of California, San Francisco, San Francisco, California
| | - Carolina V Guimaraes
- Division Chief, Pediatric Radiology, Lucile Packard Children's Hospital at Stanford, Stanford, California
| | - Mai-Lan Ho
- Nationwide Children's Hospital, Columbus, Ohio
| | - H F Samuel Lam
- Sutter Medical Center Sacramento, Sacramento, California; American College of Emergency Physicians
| | - Mohit Maheshwari
- Director of Pediatric Neuroradiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David M Mirsky
- Director of the Pediatric Neuroradiology Fellowship, Children's Hospital Colorado, Aurora, Colorado
| | - Helen R Nadel
- Lucile Packard Children's Hospital at Stanford, Stanford, California
| | - Sonia Partap
- Neuro-Oncology Fellowship Director, Stanford University, Stanford, California; American Academy of Pediatrics
| | - Gary R Schooler
- Associate Division Director, Pediatric Radiology, UT Southwestern Medical Center, Dallas, Texas
| | | | | | | | - Cynthia K Rigsby
- Specialty Chair; Chair, Medical Imaging Department, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Crowley LM, Mazzaccaro RJ, Dunn AL, Bauch SE, Greenberg MR. Don't Forget the Flu - Determining the Etiology of Infective Myositis in a Child: A Case Report. Clin Pract Cases Emerg Med 2021; 5:105-108. [PMID: 33560965 PMCID: PMC7872606 DOI: 10.5811/cpcem.2020.12.50405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/18/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Infective myositis is an acute, self-limited condition, rarely occurring in children with recent viral infections. The condition is often overlooked by emergency physicians when endeavoring to exclude other diagnoses included in the differential. Diagnosis of the condition can be difficult when based purely on clinical presentation because it shares symptoms with much more concerning neurological illnesses. A few simple laboratory tests are indicated to reach the correct diagnosis. Case Report The following case report describes a three-year-old female diagnosed with a recent upper respiratory tract infection presenting to the emergency department with complaints of fatigue and inability to walk. She was diagnosed with an influenza-like illness three days prior by her pediatrician, the symptoms of which had mostly resolved by the time of presentation. Conclusion Muscle weakness and abnormal, uncoordinated gait with an acute upper respiratory tract infection in a child may be cause for concern, prompting unnecessary work-up. Emergency physicians should be aware of the signs and symptoms of influenza-associated infective myositis in children, especially during influenza season.
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Affiliation(s)
- Lauren M Crowley
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania
| | - Richard J Mazzaccaro
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Lehigh Valley Health Network, Department of Pediatrics, Allentown, Pennsylvania
| | - Amy Lewis Dunn
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Division of Pediatric Emergency Medicine, Allenton, Pennsylvania
| | - Sarah E Bauch
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania
| | - Marna Rayl Greenberg
- University of South Florida Morsani College of Medicine, Lehigh Valley Campus, Lehigh Valley Health Network, Department of Emergency and Hospital Medicine, Allentown, Pennsylvania
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Garone G, Reale A, Vanacore N, Parisi P, Bondone C, Suppiej A, Brisca G, Calistri L, Cordelli DM, Savasta S, Grosso S, Midulla F, Falsaperla R, Verrotti A, Bozzola E, Vassia C, Da Dalt L, Maggiore R, Masi S, Maltoni L, Foiadelli T, Rossetti A, Greco C, Marino S, Di Paolantonio C, Papetti L, Urbino AF, Rossi R, Raucci U. Acute ataxia in paediatric emergency departments: a multicentre Italian study. Arch Dis Child 2019; 104:768-774. [PMID: 30948362 DOI: 10.1136/archdischild-2018-315487] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To 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 DESIGN This 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. RESULTS 509 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). CONCLUSIONS The 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.
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Affiliation(s)
- Giacomo Garone
- University Hospital Pediatric Department, Bambino Gesù Children's Hospital IRCCS, University of Rome Tor Vergata, Rome, Italy
| | - Antonino Reale
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Nicola Vanacore
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Pediatric Hospital, Turin, Italy
| | - Agnese Suppiej
- Child Neurology and Clinical Neurophysiology, Department of Woman and Child Health, University of Padua, Padova, Italy.,Department of Medical Sciences, Pediatric Section, University of Ferrara, Ferrara, Italy
| | - Giacomo Brisca
- Pediatric Emergency Department, Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Lucia Calistri
- Pediatric Emergency Unit, Anna Meyer Children's Hospital, Florence, Italy
| | | | - Salvatore Savasta
- Department of Pediatrics, Fondazione Policlinico San Matteo IRCCS, University of Pavia, Pavia, Italy
| | - Salvatore Grosso
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Fabio Midulla
- Pediatric Emergency Unit, Department of Pediatrics, Child Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Raffaele Falsaperla
- Unit of Pediatrics and Emergency Pediatrics, AOU Policlinico Vittorio Emanuele, Catania, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy
| | - Elena Bozzola
- Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Cristina Vassia
- Department of Pediatric Emergency, Regina Margherita Pediatric Hospital, Turin, Italy
| | - Liviana Da Dalt
- Pediatric Emergency Department, Department of Woman's and Child Health, University of Padova, Padova, Italy
| | - Rosario Maggiore
- Pediatric Emergency Department, Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Stefano Masi
- Pediatric Emergency Unit, Anna Meyer Children's Hospital, Florence, Italy
| | - Lucia Maltoni
- Child Neurology Unit, University of Bologna, Bologna, Italy
| | - Thomas Foiadelli
- Department of Pediatrics, Fondazione Policlinico San Matteo IRCCS, University of Pavia, Pavia, Italy
| | - Annalisa Rossetti
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Carla Greco
- Pediatric Emergency Unit, Department of Pediatrics, Child Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Silvia Marino
- Unit of Pediatrics and Emergency Pediatrics, AOU Policlinico Vittorio Emanuele, Catania, Italy
| | | | - Laura Papetti
- Division of Neurology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Rossella Rossi
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Segal E, Schif A, Kasis I, Ravid S. Acute ataxia in children: Common causes and yield of diagnostic work-up in the era of varicella vaccination. J Clin Neurosci 2019; 68:146-150. [PMID: 31327588 DOI: 10.1016/j.jocn.2019.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 06/15/2019] [Accepted: 07/04/2019] [Indexed: 11/30/2022]
Abstract
We aimed to identify the most common causes of acute ataxia in children in the era of widespread varicella vaccination and the yield of commonly used diagnostic work-up. This retrospective study reviewed the medical records of children who presented with ataxia of less than 72 h duration, over the last 12 years. Associated signs and symptoms, laboratory, EEG and neuroimaging studies, final diagnosis and clinical findings at discharge and during follow-up were studied. A total of 58 patients (35 boys, 23 girls), mean age 4.9 ± 3.8 years, were enrolled. The most common etiology of acute ataxia in our study was post-infectious acute cerebellar ataxia (50%). Children diagnosed with post-infectious acute cerebellar ataxia were significantly younger (3.48 ± 2.23 vs. 6.5 ± 3.1 years, p = 0.01), as compared with children diagnosed with infection and acute disseminated encephalomyelitis. 86% of children with post-infectious cerebellar ataxia were younger than 5 years of age. The abnormality yield of work-up studies performed in our cohort was 39% for lumbar puncture, 36% for EEG, 7% for CT scan. MRI was done in children who showed extra cerebellar signs, when vascular or demyelinating diseases were suspected and in children with prolonged symptoms and was abnormal in 8 (14%) children. We conclude that post-infectious acute cerebellar ataxia remains the most common cause of acute ataxia in children. Although lumbar puncture and neuroimaging should be considered in all children with acute cerebellar ataxia, younger children with a history of previous viral illness and no extra cerebellar signs and symptoms may benefit from watchful waiting.
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Affiliation(s)
- Elena Segal
- Neonatal Intensive Care Unit, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.
| | - Aharon Schif
- Pediatric Neurology Unit, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Imad Kasis
- Pediatric Infectious Diseases, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Sarit Ravid
- Pediatric Neurology Unit, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
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Abstract
OBJECTIVES The aim of this study was to evaluate the utility of neuroimaging in children who present to the pediatric emergency department with acute-/subacute-onset ataxia. Neuroimaging is performed in many children with ataxia to rule out serious intracranial pathology. There is, however, limited evidence to support such practice. METHODS This was a retrospective review of electronic medical records of children who presented to the emergency department with ataxia between 2007 and 2013. Patient demographics, historical features, physical examination findings, laboratory results, and neuroimaging results were collected. Neuroimaging studies that were classified as abnormal by a neuroradiologist were further reviewed and classified by the study neurologist as clinically significant or not. RESULTS The records of 141 subjects were analyzed. The most common causes of ataxia were infectious/postinfectious (36.2%) and ingestion (15.6%). Neuroimaging was performed in 104 children (73.8%). Neuroimaging was abnormal in 63 children (60.6%). However, these abnormalities were clinically significant in only 14 children (13.5%). Focal neurological findings were noted in 12 of 14 children (85.7%) with clinically significant neuroimaging. CONCLUSIONS Clinically significant neuroimaging was noted in a minority of children who presented with acute/subacute ataxia. The majority of patients with clinically significant neuroimaging had focal neurological findings on examination. Neuroimaging may not be required in all children presenting to the ED with acute ataxia, but further large-scale studies are needed to validate these findings and identify a subset of patients with ataxia in whom imaging can be deferred.
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Kılavuz FG, Ekici A, Onur H, Ekici D, Orcan CG. Intravenous Immunoglobulin: A Good Choice for Acute Cerebellar Ataxia Associated with Varicella. J Pediatr Neurosci 2019; 13:512-513. [PMID: 30937103 PMCID: PMC6413601 DOI: 10.4103/jpn.jpn_79_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Postinfectious cerebellar ataxia is the most common cause of acute ataxia in childhood. The most frequently associated viral agent is varicella. Acute cerebellar ataxia is considered benign, and its symptoms usually diminish within several weeks. We describe a 5-year-old boy who developed gait disorder and garble speech 2 weeks after chicken pox and who was successfully treated with intravenous immunoglobulin.
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Affiliation(s)
- Fatma G Kılavuz
- Department of Pediatrics, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Arzu Ekici
- Department of Pediatric Neurology, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Hatice Onur
- Department of Pediatrics, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Deniz Ekici
- Department of Pediatrics, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Cengiz G Orcan
- Department of Radiology, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
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Neuroimaging of Infectious and Inflammatory Diseases of the Pediatric Cerebellum and Brainstem. Neuroimaging Clin N Am 2017; 26:471-87. [PMID: 27423804 DOI: 10.1016/j.nic.2016.03.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cerebellar involvement by infectious-inflammatory conditions is rare in children. Most patients present with acute ataxia, and are typically previously healthy, young (often preschool) children. Viral involvement is the most common cause and ranges from acute postinfectious ataxia to acute cerebellitis MR imaging plays a crucial role in the evaluation of patients suspected of harboring inflammatory-infectious involvement of the cerebellum and brainstem. Knowledge of the imaging features of these disorders and technical competence on pediatric MR imaging are necessary for a correct interpretation of findings, which in turn prompts further management.
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Acute Ataxia in Children: A Review of the Differential Diagnosis and Evaluation in the Emergency Department. Pediatr Neurol 2016; 65:14-30. [PMID: 27789117 DOI: 10.1016/j.pediatrneurol.2016.08.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 08/26/2016] [Indexed: 11/21/2022]
Abstract
Acute ataxia in a pediatric patient poses a diagnostic dilemma for any physician. While the most common etiologies are benign, occasional individuals require urgent intervention. Children with stroke, toxic ingestion, infection, and neuro-inflammatory disorders frequently exhibit ataxia as an essential-if not the only-presenting feature. The available retrospective research utilize inconsistent definitions of acute ataxia, precluding the ability to pool data from these studies. No prospective data exist that report on patients presenting to the emergency department with ataxia. This review examines the reported causes of ataxia and attempts to group them into distinct categories: post-infectious and inflammatory central and peripheral phenomena, toxic ingestion, neurovascular, infectious and miscellaneous. From there, we synthesize the existing literature to understand which aspects of the history, physical exam, and ancillary testing might aid in narrowing the differential diagnosis. MRI is superior to CT in detecting inflammatory or vascular insults in the posterior fossa, though CT may be necessary in emergent situations. Lumbar puncture may be deferred until after admission in most instances, with suspicion for meningitis being the major exception. There is insufficient evidence to guide laboratory evaluation of serum, testing should be ordered based on clinical judgement-recommended studies include metabolic profiles and screening labs for metabolic disorders (lactate and ammonia). All patients should be reflexively screened for toxic ingestions.
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