See also

Acute poisoning 
Head injury 
Hypoglycaemia  
Metabolic disorders

Key points

1. Ataxia results from uncoordinated muscle movements that cause poor balance, a staggered gait, difficulty sitting, unsteady and/or clumsy movements 
2. Acute post-infectious cerebellar ataxia is the most common cause and a benign and self-limited condition 
3. Assessment focuses on excluding serious and treatable causes including central nervous system (CNS) infection or inflammation, stroke, toxin ingestion and mass lesions 
4. Some conditions present with an unsteady gait due to weakness (pseudoataxia). A frightened or very unwell child may also appear ataxic 

Background

Classification & causes

*Most common causes

See Common causes of ataxia for further information.

Assessment

Red flag features in Red

Any child with a red flag feature should not be considered to have acute cerebellar ataxia until further investigated. Red flag features include:

• altered conscious state
• focal neurology
• signs of raised intracranial pressure
• meningism
• posterior column loss
• weakness
• reduced reflexes

History

• Time course (acute <72 hours)
• Antecedents include:
  • recent viral illness
  • rash
  • head trauma
  • labyrinthitis (primary or secondary to otitis media)
• Cerebellar signs
• Diplopia
• Difficulty sitting
• Slurred speech 
• Vomiting
• Other neurological symptoms, including:
  • headache
  • behavioural change
  • photophobia
  • vertigo
• Family History, including:
  • metabolic disease
  • hereditary ataxia
  • migraine
  • seizure disorder
• Drugs/toxins or environmental exposures (heavy metals, gases, solvents)

Examination

• Conscious state, orientation 
• Thorough neurological examination is mandatory 
• Exclude signs of infection (fever, meningism) 

Features suggestive of Acute Cerebellar Ataxia

• Cerebellar signs
• Gait abnormalities (staggering and/or wide-based)
• A negative Romberg test
• Preservation of vibration and joint position sense
• Absence of red flag features that suggest a more serious cause

Management

Investigations

If there is a clear history of acute cerebellar ataxia with preceding viral prodrome, then no investigations may be necessary.
If ataxia does not resolve in the expected time course or another cause is suspected, consider: 

Treatment

• Children with acute cerebellar ataxia due to a viral illness can be discharged following senior doctor review and when close follow-up arrangements 
• Children who have unexplained ataxia or ataxia from non-viral causes require admission for investigation 

Consider consultation with local paediatric team when 

Child presents with an ataxia of unclear aetiology 

Consider transfer when

• Localising signs present
• Raised ICP present
• History not typical of acute cerebellar ataxia or aetiology is unclear
• Child requiring care beyond the comfort level of the hospital

For emergency advice and paediatric or neonatal ICU transfers, see Retrieval Services.

Consider discharge when 

The cause of ataxia is clear and the child is well 

Last updated December 2019