Treatment must focus on limiting secondary neuronal injuryand prevention of future strokes. Neuroprotection by maintaining control of temperature, blood pressure, glucose, andseizures is essential. Emergency thrombolysis with medications or catheterization is not yet established for children,but this is an area of active clinical research. Anticoagulants(IV heparin, subcutaneous low-molecular-weight heparin,oral warfarin) and platelet antiaggregants (aspirin) are usedfor secondary stroke prevention in some instances. For thosewith progressive CSVT, anticoagulation is the mainstay oftherapy. Long-term rehabilitation programs are required for most survivors.
Ataxia is the inability to make accurate, smooth and coordinated movements, usually due to a dysfunction of the cerebellar pathways. If either the afferent (joint position senses)or efferent cerebellar connections (cerebellum through thalamus to cerebral cortex) are disturbed, the patient has ataxia.Truncal ataxia reflects disturbances of the midline cerebellar vermis (e.g., medulloblastoma, acute postinfectious cerebellarataxia, or ethanol intoxication). Appendicular ataxia reflects disturbances of the ipsilateral cerebellar hemisphere (e.g., cystic cerebellar astrocytoma). The most common causes of acuteataxia in childhood are postinfectious acute cerebellar ataxiaand drug intoxications. Discrete lesions within the posteriorfossa, tumors (e.g., medulloblastoma, ependymoma, cerebellar astrocytoma), multiple sclerosis, strokes, and hemorrhagesmay cause ataxia. Other causes include benign paroxysmalvertigo, head trauma, seizures, postictal states, migraine,paraneoplastic opsoclonus-myoclonus syndrome associated with neuroblastoma, and inborn errors of metabolism. Congenital disorders also may produce chronic, nonprogressiveataxia. There are a number of inherited ataxia syndromes(Table 183-1).
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Inhalants Drugs of abuse *Common.
The usual symptoms of ataxia are a broad-based, unsteady gait (truncal ataxia) and intention tremor or dysmetria (overor undershooting of the target due to abnormal distance perception). An intention tremor worsens as the arm/hand approaches the target. Classically, these symptoms stem from disorders of the cerebellar pathways, but peripheral nerve lesions causing loss of proprioceptive inputs to the cerebellum (Guillain-Barré syndrome) may present with similar symptoms. In addition, weakness may intensify or mimic ataxia, so strength must be assessed, along with coordination.
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Drug intoxication is the most common cause of acute ataxia among children. Overdosage with any sedative-hypnotic agentcan produce acute ataxia and lethargy, but ataxia without lethargyusually results from intoxication with ethanol or anticonvulsantdrugs. It is important to ask about any medications or drugs ofabuse the patient may have access to. Treatment is supportive.