In young children presenting with acute cerebellar ataxia and a recent history of viral illness but without extracerebellar neurologic signs and symptoms and a negative urine drug screen, watchful waiting has been suggested [18], with imaging reserved for those with clinical deterioration. Therefore, the need for neuroimaging in the acute setting should be guided by the clinical presentation, history, and laboratory testing. CT Head In a large study assessing imaging in 104 children presenting with acute or subacute ataxia, CT abnormalities were identified in up to 29% of children [20]. Clinically significant findings have been identified on CT in 7% of children presenting with acute ataxia [18]. Although the study by Whelan et al [13] only showed significant intracranial abnormalities on CT in 2.5% of the children presenting with acute ataxia, their study was limited by the fact that only a small proportion of children had imaging. In the absence of preceding trauma, CT is useful in identifying nontraumatic acute intracranial hemorrhage but can also identify hydrocephalus, cerebellar edema, and calcifications [7,28]. However, CT is less sensitive than MRI in displaying intracranial pathology including posterior fossa abnormalities [20,26]. There is no relevant literature to support the use of contrast-enhanced head CT in the evaluation of acute childhood ataxia. CT Complete Spine There is no relevant literature to support the use of CT complete spine in the initial evaluation of a child with acute ataxia and no history of recent trauma. CTA Head and Neck CT angiography (CTA) of the head and neck may be helpful in children with ataxia due to a posterior circulation stroke, hemorrhage, or vascular malformation. However, this investigation may need to be decided based on the clinical presentation and concern for acute cerebellar infarct [7]. Stroke or vascular malformations are the etiology in only 1% to 3% of acute childhood ataxia [20,26].
Ataxia Child. In young children presenting with acute cerebellar ataxia and a recent history of viral illness but without extracerebellar neurologic signs and symptoms and a negative urine drug screen, watchful waiting has been suggested [18], with imaging reserved for those with clinical deterioration. Therefore, the need for neuroimaging in the acute setting should be guided by the clinical presentation, history, and laboratory testing. CT Head In a large study assessing imaging in 104 children presenting with acute or subacute ataxia, CT abnormalities were identified in up to 29% of children [20]. Clinically significant findings have been identified on CT in 7% of children presenting with acute ataxia [18]. Although the study by Whelan et al [13] only showed significant intracranial abnormalities on CT in 2.5% of the children presenting with acute ataxia, their study was limited by the fact that only a small proportion of children had imaging. In the absence of preceding trauma, CT is useful in identifying nontraumatic acute intracranial hemorrhage but can also identify hydrocephalus, cerebellar edema, and calcifications [7,28]. However, CT is less sensitive than MRI in displaying intracranial pathology including posterior fossa abnormalities [20,26]. There is no relevant literature to support the use of contrast-enhanced head CT in the evaluation of acute childhood ataxia. CT Complete Spine There is no relevant literature to support the use of CT complete spine in the initial evaluation of a child with acute ataxia and no history of recent trauma. CTA Head and Neck CT angiography (CTA) of the head and neck may be helpful in children with ataxia due to a posterior circulation stroke, hemorrhage, or vascular malformation. However, this investigation may need to be decided based on the clinical presentation and concern for acute cerebellar infarct [7]. Stroke or vascular malformations are the etiology in only 1% to 3% of acute childhood ataxia [20,26].