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Título

ACUTE ATAXIAS IN CHILDREN AT THE UNIDADE DE EMERGENCIA DO HCFMRP-USP: CASE SERIES

Introdução

Ataxia consists of a disturbance in gait and motor coordination and it is an uncommon neurological complaint in the pediatric age group. Children with acute ataxia represent a diagnostic challenge due to their numerous differential diagnoses.

Objetivo

Evaluate the etiology and approach of acute ataxias in a pediatric emergency service, describing the propaedeutic follow-up in the diagnostic investigation.

Método

This is a retrospective review of the medical records of children with complaints of acute ataxia treated at the Unidade de Emergência do Hospital das Clínicas de Ribeirão Preto (UE HCRP-USP). A total of five children with ataxia aged 1-18 years were identified, from January to April 2023. All children had gait ataxia as their main complaint when seeking medical care. The clinical evolution of the cases, laboratory and imaging tests used for the diagnosis of ataxia etiologies were analyzed.

Resultados e Conclusões

Of the five patients with acute gait ataxia from January to April 2023, three were female and two were male and the average age was 4.7 years. All patients had a history of acute onset of postural and/or appendicular instability. Three patients presented, in addition to ataxia, alarm signs that required immediate head computed tomography (CT), such as a history of traumatic brain injury (TBI), sudden onset headache associated with vomiting and refractory to analgesics, papilledema and altered level of consciousness . In three cases, cerebrospinal fluid collection was also necessary, two of them with extension to viral PCR due to the hypothesis of post-infectious cerebellitis and one of them due to an imaging finding suggestive of neoplasia. Only in one case was post-infectious cerebellitis confirmed. In two of the cases, the etiology of the ataxia was defined only by imaging findings, one of them being a subdural hematoma secondary to TBI and the other a venous malformation in the cerebellar hemisphere. Only one case has an unknown etiology, with spontaneous improvement of the ataxia and complementary exams without alterations.
In just four months, five cases of acute ataxias were treated, registering a high incidence in the service, despite the condition being uncommon in the pediatric age group. The most common cause of acute ataxias is post-infectious cerebellitis, found in only one of the recorded cases. Although one of the cases remains undiagnosed, it is concluded that there is a good rate of etiologies defined in the service.

Palavras Chave

acute ataxias; children ; diagnoses

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