Ataxia is a vague term. Disease processes from the cerebral cortex down to the muscle can produce ataxia. Thus, it is not a localizable symptom, and other aspects of the clinical state are necessary to clarify the localization of the disorder. The neurologic history and examination will clarify the nature of acute ataxia.

The development of acute ataxia in a child is a dramatic event for both families and physicians. The physician evaluating the ataxic patient should be thinking foremost about common, treatable causes. Generally, this includes infectious and metabolic causes. As in most neurologic disorders, the history and physical examination provide important and critical information. A wide differential diagnosis must be entertained (Table 1).

CLINICAL HISTORY

The history of the onset and nature of the ataxia can provide valuable clues to the diagnosis. Specific information should be sought concerning the exact nature of the ataxia; does it involve just the limbs, or are truncal, postural, or eye movements also affected? The presence of associated neurologic symptoms such as weakness, headache, head tilt, or lethargy may provide direction to the differential diagnostic thinking. Systemic symptoms such as fever or concomitant or antecedent illness are also important. Preceding viral infections should be carefully reported. Viral diseases such as varicella, mononucleosis, influenza, or mycoplasma infectoins are particularly likely to produce a postinfectious ataxia. A history of drugs or poisons that may have been accessible to the child should be sought.

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