Neonatal Intensive Care Unit, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.
Pediatric Neurology Unit, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.
J Clin Neurosci. 2019 Oct;68:146-150. doi: 10.1016/j.jocn.2019.07.008. Epub 2019 Jul 18.
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.
我们旨在确定广泛接种水痘疫苗时代儿童急性共济失调的最常见原因，以及常用诊断方法的检出率。这项回顾性研究回顾了过去 12 年来，出现持续时间少于 72 小时的急性共济失调的儿童的病历。研究了相关的体征和症状、实验室、脑电图和神经影像学研究、最终诊断以及出院时和随访期间的临床发现。共纳入了 58 例（35 例男孩，23 例女孩），平均年龄为 4.9±3.8 岁。在我们的研究中，急性共济失调的最常见病因是感染后急性小脑性共济失调（50%）。与诊断为感染和急性播散性脑脊髓炎的儿童相比，诊断为感染后急性小脑性共济失调的儿童年龄明显较小（3.48±2.23 岁 vs. 6.5±3.1 岁，p=0.01）。86%的感染后小脑性共济失调患儿年龄小于 5 岁。我们队列中进行的检查异常检出率为腰椎穿刺 39%，脑电图 36%，CT 扫描 7%。当怀疑血管或脱髓鞘疾病时，或当症状持续时间较长时，对出现小脑外体征的儿童进行 MRI 检查，有 8 例（14%）患儿 MRI 异常。我们得出结论，感染后急性小脑性共济失调仍然是儿童急性共济失调的最常见原因。尽管在所有急性小脑性共济失调患儿中都应考虑进行腰椎穿刺和神经影像学检查，但对于有既往病毒感染史且无小脑外体征和症状的较小儿童，可能需要密切观察。
