imagem top

2020

ANUÁRIO DO HOSPITAL
DONA ESTEFÂNIA

CHULC LOGOlogo HDElogo anuario

ATAXIA IN YOUNG CHILDREN. WHICH ETIOLOGY?

Vânia Sousa1, Inês Moreira2, Maria João Brito1

1 Unidade de Infecciologia, Hospital Dona Estefânia - CHLC EPE. Lisboa
2 Unidade de Otorrinolaringologia, Hospital Dona Estefânia - CHLC EPE. Lisboa

62º Congreso da Asociacion Española de Pediatría. Sevilla. 6 a 8/6/2013. (apresentação oral)

Introduction: Acute ataxia is a rare disorder in children. The central causes such as cerebellar ataxia or post-infectious acute cerebellitis and poisoning are the most frequently mentioned. The peripheral vestibular disorders such as vestibular neuritis and labyrinthitis are rare etiologies. They are often related to inflammation, viral upper respiratory tract.

Case report:
Case 1: Boy, 22 months old, previously healthy, observed by vomiting, low-grade fever (38 ° C) and left gait imbalance with two days of evolution. The remaining physical examination was normal including neurological. Search for toxic compounds yield negative. The head CT scan and cultural and cytochemical examination of CSF revealed no changes. The PCR for enterovirus in CSF was positive. The "head impulse test" and "head shaking test" caused bilateral discomfort without nystagmus. The tympanogram had no change; he was diagnosed with vestibular neuritis by enterovirus infection. He was treated with diphenhydramine with progressive and complete recovery from symptoms.
Case 2: Girl, 2 years old, with a history of recurrent upper respiratory infections, observed by imbalance in gait and frequent falls, with a week of evolution. She was showing a broad-based unsteady gait and otoscopy seromucous revelaled bilateral otitis, the remaining physical examination was normal. Search for toxic compounds yield negative. The cytochemical examination, cultural and search of virus in cerebrospinal fluid were negative. The EEG also had no changes. CT scan of brain and mastoids revealed total middle bilateral ear filled with component of tissue density.The tympanogram had a flattened curve. Further the diagnosis of hypothesized acute labyrinthitis, she underwent meringotomia and tubing transtimpanicos. The outcome was excellent with normal gait.

Discussion: The vestibular entity is a tad difficult to diagnose in young children because of the subjectivity of the signs and symptoms, which requires a high index of suspicion. Diagnosis is usually clinical with acute onset of vertigo associated with nausea, vomiting and gait. Usually has a benign and self-limited course from days to weeks.

Key Words:  ataxia, vestibular entity