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Drug-induced ataxia — RACP Paediatrics MCQ

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EasyNeurologyDrug-induced ataxiaRACP Paediatrics

A 15-year-old is brought to the ED with acute ataxia, dysarthria, and drowsiness. His friends are reluctant to provide a history. Pupils are 7 mm bilaterally and sluggishly reactive. There is horizontal nystagmus. Heart rate is 60 bpm. What is the most likely cause?

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Correct answer: C — Drug/toxin ingestion

Acute ataxia with drowsiness, mydriasis, and nystagmus in an adolescent with reluctant companions should raise suspicion for drug or toxin ingestion. Common causes include alcohol, benzodiazepines, anticonvulsants, and recreational drugs. Toxicology screen (blood and urine) should be performed. The social context is an important clue.

Reference: RCH Melbourne – 2023 – Ataxia CPG; Australian Therapeutic Guidelines – 2024 – Toxicology