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Acute cerebellar ataxia — RACP Paediatrics MCQ

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EasyNeurologyAcute cerebellar ataxiaRACP Paediatrics

A 3-year-old develops acute onset truncal ataxia and wide-based gait 2 weeks after varicella infection. There is no headache, vomiting, or cranial nerve abnormality. MRI brain is normal. The child is well but unsteady. What is the most likely diagnosis?

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Correct answer: A — Acute cerebellar ataxia (post-infectious)

Acute cerebellar ataxia (ACA) is the most common cause of acute ataxia in children aged 2-6 years. It typically follows a viral illness (varicella is classic) by 1-3 weeks. MRI is normal. Symptoms are usually self-limiting and resolve over weeks to months. The main differential to exclude urgently is a posterior fossa mass (which would typically show raised ICP features and abnormal MRI).

Reference: RCH Melbourne – 2023 – Ataxia CPG; RACP Paediatric Curriculum – Neurology