Department of Neurology, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Pediatr Neurol. 2013 Jul;49(1):15-24. doi: 10.1016/j.pediatrneurol.2012.12.005. Epub 2013 May 16.
Evaluation of acute ataxia in a child poses a dilemma for the clinician in determining the extent and timing of initial screening tests. This article reviews the evidence concerning the diagnostic yield of commonly ordered tests in evaluating the child with acute ataxia. The literature revealed the following frequencies of laboratory screening abnormalities in children with acute ataxia: CT (∼2.5%), MRI (∼5%), lumbar puncture (43%), EEG (42%), and toxicology (49%). In most studies, abnormalities detected by these screening tests were nondiagnostic. There are insufficient data to assess yields of testing for autoimmune disorders or inborn errors of metabolism. A toxicology screen should be considered in all children presenting with acute ataxia. Neuroimaging should be considered in all children with new onset ataxia. Cerebrospinal fluid analysis has limited diagnostic specificity unless clinically indicated. Studies to examine neurophysiology testing did have sufficient evidence to support their use. There is insufficient evidence to establish a role for autoantibody testing or for routine screening for inborn error of metabolism in children presenting with acute ataxia. Finally, in a child presenting with ataxia and opsoclonus myoclonus, urine catecholamine testing for occult neuroblastoma is recommended. Nuclear scan may be considered, however, there is insufficient evidence for additional body imaging.
评估儿童急性共济失调给临床医生带来了困境，难以确定初始筛查测试的范围和时间。本文综述了评估急性共济失调儿童时常用检查的诊断价值的证据。文献显示，急性共济失调儿童的实验室筛查异常有以下频率：CT（约 2.5%）、MRI（约 5%）、腰椎穿刺（43%）、脑电图（42%）和毒理学检查（49%）。在大多数研究中，这些筛查测试发现的异常无诊断价值。评估自身免疫性疾病或先天性代谢异常的检测结果的资料不足。所有出现急性共济失调的儿童都应考虑进行毒理学筛查。所有新发共济失调的儿童都应考虑神经影像学检查。除非有临床指征，否则脑脊液分析的诊断特异性有限。神经生理学检查的研究有足够的证据支持其应用。对于出现急性共济失调的儿童，自身抗体检测或常规筛查先天性代谢异常的作用证据不足。最后，对于出现共济失调和眼震-肌阵挛的儿童，建议进行尿儿茶酚胺检测以排除隐匿性神经母细胞瘤。核扫描可能有必要，但对于额外的全身成像，证据不足。
