⚖️ Ataxia · Acute, Intermittent & Progressive · Pediatric Diagnostic Tool

Schwartz Clinical Handbook — Chapter 17 · Acute cerebellar ataxia · GBS · Opsoclonus-myoclonus · Posterior fossa tumor · Migraine · Toxic ingestion

Select onset (acute/recurrent/chronic), associated symptoms, nystagmus type, and history to differentiate peripheral vs central causes and guide neuroimaging/lumbar puncture.
⚠️ Red flags: acute progressive ataxia, morning vomiting, new headache, focal deficits → urgent MRI for posterior fossa mass.

📋 Step 1 — Ataxia pattern & neurologic features
📌 Diagnostic impressions
📖 Schwartz Ch 17

Select onset, associated findings (nystagmus, opsoclonus, weakness, headache), and history of viral illness/ingestion → system suggests acute cerebellar ataxia, GBS, tumor, migraine, or metabolic disorders and recommends imaging/CSF.

✔️ Acute post-infectious → acute cerebellar ataxia.
✔️ Truncal ataxia + vomiting + age <10 → posterior fossa tumor.
✔️ Opsoclonus-myoclonus → neuroblastoma until ruled out.
✔️ Episodic ataxia + family history → channelopathy / metabolic.
📘 Schwartz pearls (Chapter 17)
• MRI is imaging of choice for ataxia (CT misses posterior fossa).
• Acute cerebellar ataxia: supportive care, often resolves in weeks.
• Miller Fisher variant: ataxia + ophthalmoplegia + areflexia → GBS.
• Toxic ingestion: antihistamines, anticonvulsants, ethanol.