title: Evaluation of the child with acute ataxia: a systematic review.
abstract: Evaluation of acute ataxia in a child poses a dilemma for the clinician in determining the extent and timing of initial screening tests. This article reviews the evidence concerning the diagnostic yield of commonly ordered tests in evaluating the child with acute ataxia. The literature revealed the following frequencies of laboratory screening abnormalities in children with acute ataxia: CT (∼2.5%), MRI (∼5%), lumbar puncture (43%), EEG (42%), and toxicology (49%). In most studies, abnormalities detected by these screening tests were nondiagnostic. There are insufficient data to assess yields of testing for autoimmune disorders or inborn errors of metabolism. A toxicology screen should be considered in all children presenting with acute ataxia. Neuroimaging should be considered in all children with new onset ataxia. Cerebrospinal fluid analysis has limited diagnostic specificity unless clinically indicated. Studies to examine neurophysiology testing did have sufficient evidence to support their use. There is insufficient evidence to establish a role for autoantibody testing or for routine screening for inborn error of metabolism in children presenting with acute ataxia. Finally, in a child presenting with ataxia and opsoclonus myoclonus, urine catecholamine testing for occult neuroblastoma is recommended. Nuclear scan may be considered, however, there is insufficient evidence for additional body imaging.
authors.affiliation: Department of Neurology, Medical College of Wisconsin, Milwaukee, WI 53226, USA. hwhelan@mcw.edu
authors.forename: Harry T
authors.initials: HT
authors.lastname: Whelan
authors.forename: Sumit
authors.initials: S
authors.lastname: Verma
authors.forename: Yan
authors.initials: Y
authors.lastname: Guo
authors.forename: Farouq
authors.initials: F
authors.lastname: Thabet
authors.forename: Xiuhua
authors.initials: X
authors.lastname: Bozarth
authors.forename: Michelle
authors.initials: M
authors.lastname: Nwosu
authors.forename: Akshat
authors.initials: A
authors.lastname: Katyayan
authors.forename: Venu
authors.initials: V
authors.lastname: Parachuri
authors.forename: Katie
authors.initials: K
authors.lastname: Spangler
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Ruggeri
authors.forename: Sindhu
authors.initials: S
authors.lastname: Srivatsal
authors.forename: Guojun
authors.initials: G
authors.lastname: Zhang
authors.forename: Stephen
authors.initials: S
authors.lastname: Ashwal
mesh_terms: D000208:Acute Disease; D001259:Ataxia / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D002648:Child; D003952:Diagnostic Imaging / Q000379:methods* / Q000639:trends; D006801:Humans; D012189:Retrospective Studies