*Correspondence: amandambaraujo@gmail.com.
Abstract
Background: Ataxia consists of a disturbance in gait and motor coordination, and it is an uncommon
neurological complaint in the pediatric age group. Children with acute ataxia represent
a diagnostic challenge due to their numerous differential diagnoses.
Objective: Evaluate the etiology and approach of acute ataxias in a pediatric emergency service,
describing the propaedeutic follow-up in the diagnostic investigation.
Method: This is a retrospective review of the medical records of children with complaints
of acute ataxia treated at the Unidade de Emergência do Hospital das Clínicas de Ribeirão
Preto (UE HCRP-USP). A total of five children with ataxia aged 1-18 years were identified,
from January to April 2023. All children had gait ataxia as their main complaint when
seeking medical care. The clinical evolution of the cases, laboratory and imaging
tests used for the diagnosis of ataxia etiologies were analyzed.
Results: Of the five patients with acute gait ataxia from January to April 2023, three were
female and two were male and the average age was 4.7 years. All patients had a history
of acute onset of postural and/or appendicular instability. Three patients presented,
in addition to ataxia, alarm signs that required immediate head computed tomography
(CT), such as a history of traumatic brain injury (TBI), sudden onset headache associated
with vomiting and refractory to analgesics, papilledema and altered level of consciousness.
In three cases, cerebrospinal fluid collection was also necessary, two of them with
extension to viral PCR due to the hypothesis of post-infectious cerebellitis and one
of them due to an imaging finding suggestive of neoplasia. Only in one case was post-infectious
cerebellitis confirmed. In two of the cases, the etiology of the ataxia was defined
only by imaging findings, one of them being a subdural hematoma secondary to TBI and
the other a venous malformation in the cerebellar hemisphere. Only one case has an
unknown etiology, with spontaneous improvement of the ataxia and complementary exams
without alterations.
Conclusion: In just four months, five cases of acute ataxias were treated, registering a high
incidence in the service, despite the condition being uncommon in the pediatric age
group. The most common cause of acute ataxias is post-infectious cerebellitis, found
in only one of the recorded cases. Although one of the cases remains undiagnosed,
it is concluded that there is a good rate of etiologies defined in the service.
