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Acute cerebellar ataxia in childhood: initial approach in the emergency department

Ariel A Salas1, Alejandra Nava

  • 1Departamento de Infectologia, Hospital Infantil de Mexico Federico Gomez, Mexico, DF, Mexico. ariel.a.salas@gmail.com

Emergency Medicine Journal : EMJ
|June 29, 2010
PubMed

Insights

Acute cerebellar ataxia is common in children, often following varicella infection. This case highlights the autoimmune nature of post-varicella acute cerebellar ataxia (PVACA) in an unvaccinated child, emphasizing diagnostic considerations.

Area of Science:

  • Neurology
  • Immunology
  • Paediatrics

Background:

  • Acute childhood ataxia is a frequent emergency department presentation.
  • Life-threatening causes of pure ataxia are rare in children, necessitating a stepwise diagnostic approach.
  • Acute cerebellar ataxia is the leading cause, seen in 30-50% of cases.

Observation:

  • Post-varicella acute cerebellar ataxia (PVACA) is the most common neurological complication of varicella.
  • PVACA occurs in approximately 1 in 4000 children under 15, even post-vaccination.
  • The case involves an unvaccinated child presenting with PVACA.

Findings:

  • The described case underscores the autoimmune pathogenesis of PVACA.
  • This condition, though rare, is the most frequent neurological complication of varicella infection.
  • The autoimmune response targets the cerebellum following viral infection.

Implications:

  • Emergency physicians should consider PVACA in children with acute ataxia, particularly after varicella.
  • Understanding the autoimmune basis is crucial for diagnosis and management.
  • Further discussion on diagnostic controversies and treatment strategies is warranted.

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