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 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 and 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