Acute ataxia in paediatric emergency departments: a multicentre Italian study

Giacomo Garone, Antonino Reale, Nicola Vanacore, Pasquale Parisi, Claudia Bondone, Agnese Suppiej, Giacomo Brisca, Lucia Calistri, Duccio Maria Cordelli, Salvatore Savasta, Salvatore Grosso, Fabio Midulla, Raffaele Falsaperla, Alberto Verrotti, Elena Bozzola, Cristina Vassia, Liviana Da Dalt, Rosario Maggiore, Stefano Masi, Lucia MaltoniThomas Foiadelli, Annalisa Rossetti, Carla Greco, Silvia Marino, Claudia Di Paolantonio, Laura Papetti, Antonio Francesco Urbino, Rossella Rossi, Umberto Raucci

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: To evaluate the causes and management of acute ataxia (AA) in the paediatric emergency setting and to identify clinical features predictive of an underlying clinically urgent neurological pathology (CUNP).

STUDY DESIGN: This is a retrospective medical chart analysis of children (1-18 years) attending to 11 paediatric emergency departments (EDs) for AA in an 8-year period. A logistic regression model was applied to identify clinical risk factors for CUNP.

RESULTS: 509 patients (mean age 5.8 years) were included (0.021% of all ED attendances). The most common cause of AA was acute postinfectious cerebellar ataxia (APCA, 33.6%). Brain tumours were the second most common cause (11.2%), followed by migraine-related disorders (9%). Nine out of the 14 variables tested showed an OR >1. Among them, meningeal and focal neurological signs, hyporeflexia and ophthalmoplegia were significantly associated with a higher risk of CUNP (OR=3-7.7, p<0.05). Similarly, the odds of an underlying CUNP were increased by 51% by each day from onset of ataxia (OR=1.5, CI 1.1 to 1.2). Conversely, a history of varicella-zoster virus infection and vertigo resulted in a significantly lower risk of CUNP (OR=0.1 and OR=0.5, respectively; p<0.05).

CONCLUSIONS: The most frequent cause of AA is APCA, but CUNPs account for over a third of cases. Focal and meningeal signs, hyporeflexia and ophthalmoplegia, as well as longer duration of symptoms, are the most consistent 'red flags' of a severe underlying pathology. Other features with less robust association with CUNP, such as seizures or consciousness impairment, should be seriously taken into account during AA evaluation.

Original languageEnglish
JournalArchives of Disease in Childhood
DOIs
Publication statusE-pub ahead of print - Apr 4 2019

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    Garone, G., Reale, A., Vanacore, N., Parisi, P., Bondone, C., Suppiej, A., Brisca, G., Calistri, L., Cordelli, D. M., Savasta, S., Grosso, S., Midulla, F., Falsaperla, R., Verrotti, A., Bozzola, E., Vassia, C., Da Dalt, L., Maggiore, R., Masi, S., ... Raucci, U. (2019). Acute ataxia in paediatric emergency departments: a multicentre Italian study. Archives of Disease in Childhood. https://doi.org/10.1136/archdischild-2018-315487