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Acute cerebellar ataxia — RACP Paediatrics MCQ

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ModerateNeurology and neurodevelopmentAcute cerebellar ataxiaRACP Paediatrics

A 4-year-old becomes unsteady two weeks after chickenpox. He is afebrile, alert and has truncal ataxia, nystagmus and intention tremor; power and reflexes are normal and symptoms have begun to improve over 48 hours. What is the most likely diagnosis?

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Correct answer: D — Post-infectious acute cerebellar ataxia

A well child with acute ataxia after varicella and early improvement is typical of post-infectious acute cerebellar ataxia. A posterior fossa tumour usually produces progressive symptoms, raised intracranial pressure or persistent focal findings. The pearl is that red flags such as headache, vomiting, altered consciousness or progression should prompt urgent neuroimaging.

Reference: RCH Clinical Practice Guidelines: Ataxia; Therapeutic Guidelines (eTG)