Diagnostic Approach and Management of Ataxia in Children

Clinical Features and Diagnostic Evaluation

The American College of Radiology recommends MRI of the brain as the first-line diagnostic approach for children with ataxia, as it is more sensitive than CT in detecting intracranial pathology 1
Acute ataxia in children typically presents within 72 hours, with postinfectious cerebellar ataxia and brain tumors being the most common causes requiring immediate intervention 2, 3
The American College of Radiology suggests that infectious and postinfectious disorders account for 33.6% of cases of acute ataxia in children, while brain tumors account for 11.2% of cases 4
Trauma-related ataxia occurs in approximately 5% of cases 5
The American College of Radiology recommends that CT imaging may be considered when MRI is not immediately available and there is concern for acute infectious causes or when there is a history of recent trauma with concern for intracranial hemorrhage 2, 5, 6
MRI of the spine is recommended if there is concern for conditions that may have spinal cord involvement, such as acute disseminated encephalomyelitis 5
MR angiography (MRA) of head and neck is recommended if there is concern for posterior circulation stroke, hemorrhage, or vascular malformation 1, 6
The American College of Radiology suggests that MIBG scan and/or MRI of chest, abdomen, and pelvis may be necessary in cases of opsoclonus-myoclonus-ataxia syndrome to evaluate for neuroblastoma 7, 6

The American College of Radiology recommends supportive care for postinfectious cerebellar ataxia, as most cases are self-limiting 4
Neurosurgical consultation is recommended for potential resection of brain tumors 4
Removal of offending agent and supportive care is recommended for toxic causes of ataxia 2
Management of intracranial injury according to type and severity is recommended for traumatic causes of ataxia 5

The American College of Radiology recommends that a normal brain MRI supports the diagnosis of benign conditions, such as acute cerebellar ataxia or toxic exposure, in the appropriate clinical context 8
The presence of somnolence, encephalopathy, focal motor weakness, or cranial nerve involvement increases the likelihood of urgent pathology, with 86% of significant findings having additional focal signs 9
The duration of symptoms, with symptoms lasting more than 3 days in children over 3 years, increases the yield of significant findings 9

The American College of Radiology recommends that all patients undergo a toxicology screen, metabolic profile, including glucose, electrolytes, liver and kidney function, lactate, and ammonia levels 8

The American College of Radiology recommends that patients with acute cerebellar ataxia or toxic exposure receive supportive care, with identification and removal of the offending agent in cases of intoxication 8, 9
Hospitalization and close observation are recommended for patients with signs of extracerebellar involvement, asymmetric examination, or prolonged symptoms 9

The American College of Radiology recommends that patients be reevaluated in 24-48 hours to confirm improvement, even in cases of benign conditions 9