Pediatric emergency medicine trisk 2647 2647

The child develops acute truncal unsteadiness with a variable degree of distal
motor difficulty, such as tremor and dysmetria. Dysarthria and nystagmus are
variably present. Some children have nausea and vomiting, presumably caused by
vertigo. Headache is rare.
When acute ataxia follows a viral illness in a child with no other neurologic
findings, the diagnosis of APCA may be made on clinical grounds. In atypical
cases, CT or MRI may be necessary to rule out a cerebellar mass. LP is not
usually necessary in typical cases; if performed, it reveals a mild CSF pleocytosis
in approximately half of the cases.
Treatment is supportive. Resolution of symptoms is complete in most children
within 2 weeks of onset, but mild residual neurologic deficits have been reported
in 10% to 30% of cases. Varicella-associated cases appear to have the most
benign prognosis.
Cerebellitis and ADEM are the two other postinfectious syndromes that present
with acute ataxia in children. Acute cerebellitis presents with ataxia and altered
mental status to suggest increased ICP. ADEM and multiple sclerosis can present
with acute ataxia and have multifocal demyelinating changes on MRI, but ADEM
presents with encephalopathy.
Benign Paroxysmal Vertigo
Benign paroxysmal vertigo is an illness that affects children primarily between 1
and 4 years of age, although it can occur any time during the first decade. It
manifests with acute episodes of dizziness and imbalance, lasting seconds to
minutes. Between episodes, the child is asymptomatic. During the spell, the child
characteristically becomes frightened and pale but does not lose consciousness.
He or she may have associated nausea, vomiting, or visual disturbance. The
physical examination is usually normal except for nystagmus, which may be
present. Although the cause of this illness is unknown, it is believed to be a
migraine variant. Many children go on to develop more typical migraine
headaches later, and there is often a family history of migraine disease. As the
name suggests, the course of benign paroxysmal vertigo is self-limiting and
benign, and treatment is supportive.

MOVEMENT DISORDERS
Goals of Treatment
Involuntary movements are components of many CNS disorders, tend to be
complex, and are diagnosed by associated neurologic findings. Classifying