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Arch Dis Child. 2019 Apr 4. pii: archdischild-2018-315487. doi: 10.1136/archdischild-2018-315487. [Epub ahead of print]

Acute ataxia in paediatric emergency departments: a multicentre Italian study.

Author information

1
University Hospital Pediatric Department, Bambino Gesù Children's Hospital IRCCS, University of Rome Tor Vergata, Rome, Italy.
2
Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
3
National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy.
4
Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
5
Department of Pediatric Emergency, Regina Margherita Pediatric Hospital, Turin, Italy.
6
Child Neurology and Clinical Neurophysiology, Department of Woman and Child Health, University of Padua, Padova, Italy.
7
Department of Medical Sciences, Pediatric Section, University of Ferrara, Ferrara, Italy.
8
Pediatric Emergency Department, Giannina Gaslini Children's Hospital, Genoa, Italy.
9
Pediatric Emergency Unit, Anna Meyer Children's Hospital, Florence, Italy.
10
Child Neurology Unit, University of Bologna, Bologna, Italy.
11
Department of Pediatrics, Fondazione Policlinico San Matteo IRCCS, University of Pavia, Pavia, Italy.
12
Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy.
13
Pediatric Emergency Unit, Department of Pediatrics, Child Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.
14
Unit of Pediatrics and Emergency Pediatrics, AOU Policlinico Vittorio Emanuele, Catania, Italy.
15
Department of Pediatrics, University of L'Aquila, L'Aquila, Italy.
16
Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
17
Pediatric Emergency Department, Department of Woman's and Child Health, University of Padova, Padova, Italy.
18
Division of Neurology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
#
Contributed equally

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.

KEYWORDS:

ataxia; cerebellitis; child; emergency department; neurology

Conflict of interest statement

Competing interests: None declared.

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