1. Morning Report
October 26, 2010

2. Ataxia Disturbance in the smooth, accurate coordination of movements
Most commonly unsteady gait
Result of cerebellar dysfunction or proprioception

3. Ataxia Causes Acute Intermittent Chronic Infections Post-infectious
Toxins
Tumors
Trauma
Stroke
Intermittent
Migraine
Seizure
IEM
Benign paroxysmal vertigo
Chronic
Congenital anomalies
Degenerative diseases
Hereditary ataxias

4. Life-threatening Ataxia
Uncommon
Mass effect
Increased ICP
Vomiting, HA, papilledema
Tumors
45-60% of brain tumors are brainstem or cerebellar
May be slowly progressive
Early morning HA with N/V
Papilledema, focal signs, cranial neuropathies

5. Life-threatening Ataxia
ICH
Trauma or vascular malformation
Stroke
Vertebral or basilar artery disease
SCD, Hypercoagulable, Homocystinuria

6. Life-threatening Ataxia
Infection
Abscess
Otitis, mastoiditis
Enchephalitis
Brainstem, rare
CN changes, seizures, AMS
ADEM
Uncommon
Inflammatory demyelinating disease following infection

7. Acute Ataxia Acute Cerebellar Ataxia Self-limited Post-infectious
2-5 years old
Diagnosis of exclusion

8. Acute Ataxia Guillain-Barre Syndrome Acute inflammatory demyelinating
Post-infectious immune response
15% lose sensory input to cerebellum
Miller Fisher variant
Ataxia, areflexia and opththalmoplegia

9. Acute Ataxia Labyrinthitis Inflammation of vestibular apparatus
Viral or bacterial infection
Signs and Symptoms
Hearing loss
Vomiting
Intense vertigo

10. Acute Ataxia Toxic Exposure 30% ingestion Other symptoms
AMS, lethargy, confusion, inappropriate speech or behavior
Associated meds
Anticonvulsants, lead, CO, inhalants, alcohol, benzos, other drugs of abuse

11. Acute Ataxia Migraine Trauma Basilar or familial hemiplegic migraines
Episodic
Trauma
Mild traumatic brain injury

12. Acute Ataxia Other Causes Tick paralysis Hypoglycemia Seizures
Conversion disorder
IEM
Congenital anomalies
Degenerative
Genetic

14. History Onset Associated symptoms Access to medications Hx of trauma
Fever, HA, N/V
Weakness
Access to medications
Hx of trauma
Recent infection or vaccination
Previous episodes
Family History

15. Physical Exam Physical findings pertinent to suspected diagnosis Neuro
Papilledema
Mental status
Cranial nerves
Motor
Sensory
Reflexes
Cerebellar
Gait, speech, coordination

16. Evaluation and Treatment
Tox screen
Blood glucose
Metabolic eval
CSF
Infection
Neuroimaging
MRI preferred
Treat underlying cause