Gieron-Korthals M A, Westberry K R, Emmanuel P J
Department of Pediatrics, University of South Florida College of Medicine, Tampa.
J Child Neurol. 1994 Oct;9(4):381-4. doi: 10.1177/088307389400900408.
Forty cases of acute childhood ataxia were retrospectively assessed for main etiologies and for factors that can be used in planning the most effective and cost-efficient management. The most common discharge diagnoses were acute cerebellar ataxia, ingestion, and Guillain-Barré syndrome, encompassing 80% of all cases. The remaining 20% included various isolated causes. Acute cerebellar ataxia was primarily seen in children less than 6 years of age who had preceding viral syndromes or varicella. Ingestions were also most frequent in children less than 6 years of age, but a second peak occurred in adolescents. History was suggestive of drug ingestion in 61.5% of cases, and in addition to ataxia, lethargy was an associated symptom. The drug screen was the most informative laboratory test, with 17 of 35 being positive. Lumbar punctures were positive in seven of 25, with pleocytosis in six and elevated protein in two. Of 26 computed tomographic scans and magnetic resonance imaging scans performed, only two were positive, one for cerebellar infarct and one for cerebral edema. Acute ataxia in childhood has multiple etiologies, but it is usually due to a benign, self-limited process. A thorough history, physical examination, and drug screen should be performed before other costly and invasive tests and before admission to the hospital. This approach may eliminate the need for hospitalization of some patients with postinfectious acute cerebellar ataxia and ingestion. Neuroimaging studies should be used judiciously in the evaluation of acute ataxia, considering their low yield.
对40例儿童急性共济失调病例进行回顾性评估，以确定主要病因以及可用于规划最有效和最具成本效益管理方案的因素。最常见的出院诊断为急性小脑性共济失调、中毒和吉兰-巴雷综合征，占所有病例的80%。其余20%包括各种孤立病因。急性小脑性共济失调主要见于6岁以下有前驱病毒综合征或水痘的儿童。中毒在6岁以下儿童中也最为常见，但在青少年中出现了第二个高峰。61.5%的病例病史提示药物中毒，除共济失调外，嗜睡是相关症状。药物筛查是最具信息量的实验室检查，35例中有17例呈阳性。25例腰椎穿刺中有7例呈阳性，6例有细胞增多，2例蛋白升高。在进行的26例计算机断层扫描和磁共振成像扫描中，只有2例呈阳性，1例为小脑梗死，1例为脑水肿。儿童急性共济失调有多种病因，但通常是由良性、自限性过程引起的。在进行其他昂贵且有创的检查以及住院治疗之前，应进行全面的病史询问、体格检查和药物筛查。这种方法可能会使一些感染后急性小脑性共济失调和中毒患者无需住院。在评估急性共济失调时，应谨慎使用神经影像学检查，因为其阳性率较低。
