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Acute cerebellar ataxia

Cerebellar ataxia; Ataxia - acute cerebellar; Cerebellitis; Post-varicella acute cerebellar ataxia; PVACA

Definition

Acute cerebellar ataxia is sudden inability to coordinate muscle movement due to disease or injury to the cerebellum. This is the area in the brain that controls muscle movement. Ataxia means loss of muscle coordination, especially of the hands and legs.

Causes

Acute cerebellar ataxia in children, particularly younger than age 3, may occur several days or weeks after an illness caused by a virus.

Viral infections that may cause this include chickenpox, Coxsackie disease, Epstein-Barr, echovirus, among others.

Other causes of acute cerebellar ataxia include:

Abscess of the cerebellum
Alcohol, medicines, insecticides, and illicit drugs
Bleeding into the cerebellum
Multiple sclerosis
Strokes of the cerebellum
Vaccination
Trauma to head and neck
Certain diseases associated with some cancers (paraneoplastic disorders)

Symptoms

Ataxia may affect movement of the middle part of the body from the neck to the hip area (the trunk) or the arms and legs (limbs).

When the person is sitting, the body may move side-to-side, back-to-front, or both. Then the body quickly moves back to a sitting upright position.

When a person with ataxia of the arms reaches for an object, the hand may sway back and forth.

Common symptoms of ataxia include:

Clumsy speech pattern (dysarthria)
Repetitive eye movements (nystagmus)
Uncoordinated eye movements
Walking problems (unsteady gait) that can lead to falls
Difficulty controlling arm movements

Exams and Tests

The health care provider will ask if the person has recently been sick and will try to rule out any other causes of the problem. Brain and nervous system examination will be done to identify the most affected areas of the nervous system.

The following tests may be ordered:

CT scan of the head
MRI scan of the head
Spinal tap
Blood tests to detect infections caused by viruses or bacteria

Treatment

Treatment depends on the cause:

If the acute cerebellar ataxia is due to bleeding, surgery may be needed.
For an ischemic stroke, medicine to thin the blood can be given. Removing a blood clot from within the blood vessels may also be needed.
Infections may need to be treated with antibiotics or antivirals.
Corticosteroids may be needed for swelling (inflammation) of the cerebellum (such as from multiple sclerosis).
Cerebellar ataxia caused by a recent viral infection may not need treatment.
Physical therapy may be needed to reduce risk of falling.

Outlook (Prognosis)

People whose condition was caused by a recent viral infection should make a full recovery without treatment in a few months. Strokes, bleeding, or infections may cause permanent symptoms.

Possible Complications

Falls may result in injury.

In rare cases, movement or behavioral disorders may persist.

When to Contact a Medical Professional

Contact your provider if any symptoms of ataxia appear.

References

Kuo SH, Lin CC, Ashizawa T. Cerebellar ataxia. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 23.

Mink JW. Movement disorders. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 615.

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Review Date: 1/23/2023

Reviewed By: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School of Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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