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Clinical Practice Guidelines

Common Causes of Ataxia

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    Classification & causes

    Acute ( <72 hours duration, previously well child)

    Episodic (recurrent ataxia)

    Chronic

    Post infectious*  
     Toxins*
    Tumours*
    Immune (eg ADEM)*
    Metabolic
    Infections
    Vascular (eg Stroke)
    Trauma
    Conversion disorder 

    Toxin ingestion  
    Basilar artery migraine
    Seizure disorder
    Metabolic 

    Brain tumours
    Hydrocephalus
    Metabolic
    Nutritional
    Congenital malformations
    Hereditary ataxias

    *Most common causes

    Acute Cerebellar Ataxia

    The most common cause of ataxia in children.

    • Commonly affects children 2 – 7 years of age.
    • Due to post-infectious autoimmune process (often varicella but may also be caused by mycoplasma, EBV, HHV6, Parvovirus B19 and enterovirus infections or occur post immunisations).
    • Usually occurs 5-10 days after a prodromal illness, with or without exanthem.
    • Acute onset of symmetrical gait ataxia. Can also have (mild) dysarthria, nystagmus.
    • Ataxia maximal at onset and usually improves within days. Full recovery usually occurs within 10 - 21 days (>90% resolve by 2months).

    Toxins

    Acute ataxia can be caused by the ingestion of drugs/toxins/complementary medicines including:  

    • Antihistamines
    • Ethanol, ethylene glycol, isopropanol
    • Anticholinergic agents or muscle relaxants
    • Essential oils, pine oil
    • Complementary medicines

    Tumours

    Brain tumours

    • Usually present with normal conscious level.
    • Signs of raised intracranial pressure (ICP).
    • Usually gradual onset, may present acutely due to haemorrhage into tumour.

    Neuroblastoma

    • Paraneoplastic encephalopathy; progressive ataxia; myoclonus, opsoclonus.

    Acute Demyelinating Encephalomyelitis (ADEM)

    Demyelinating disorder of the CNS, which is monophasic but multifocal in nature associated with encephalopathy.

    • Febrile illness 1- 4 weeks before the onset of symptoms.
    • Lethargy/irritability that can progress to coma, associated with multiple neurological deficits including pyramidal signs, optic neuritis, hemiplegia, ataxia.
    • The diagnosis is clinical; lumbar puncture may show a pleocytosis and increased protein. MRI shows multiple areas of demyelination in brain and spine,
    • Treatment is with IV methylprednisolone +/- IVIG.

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    Last updated December 2019