acute cerebellar ataxia in children
Introduction
Introduction to acute cerebellar ataxia in children Normal voluntary exercise requires the cooperative contraction of several groups of muscles. This ingenious coordination action between muscles is called synergistic exercise or mutual aid exercise. The Mutual Movement requires the participation of a full-featured deep sense, vestibule, cerebellum and extrapyramidal system. The motor coordination disorder caused by the damage of any of the above-mentioned parts is called ataxia, and the ataxia caused by the damage of different parts is different, such as sensory, vestibular, cerebellum and cerebral ataxia. According to the different causes, it can be divided into acute cerebellar ataxia, congenital metabolic abnormal ataxia and hereditary ataxia. Acute cerebellar ataxia is a group of syndromes characterized by cerebellar ataxia as the main manifestation of childhood. basic knowledge The proportion of illness: 0.004% Susceptible people: children Mode of infection: non-infectious Complications: dyskinesia
Cause
The cause of acute cerebellar ataxia in children
(1) Causes of the disease
Acute cerebellar ataxia is a multi-pathogenic syndrome. Cerebellar damage caused by autoimmune reactions after viral infection is the most common cause. Common viruses that cause acute cerebellar ataxia include chickenpox and herpes zoster. Virus, enterovirus, rubella DNA virus, mumps virus, etc., mycoplasma and bacterial infections can also cause this disease, other causes are cerebellar tumors, drugs or heavy metal poisoning (such as phenytoin, lead), congenital metabolic abnormalities, etc. .
(two) pathogenesis
Most authors believe that acute cerebellar ataxia after infection is a type of encephalitis after infection, which is an autoimmune reaction, and this immune process is limited to the cerebellum system. Some people think that the disease is directly invaded by the virus. The above two opinions were not confirmed by the acute viral cerebellitis.
Prevention
Prevention of acute cerebellar ataxia in children
1. Prevent various infectious diseases and do a variety of vaccination work.
2. Prevent excessive drug (such as phenytoin) from causing the disease.
3. Prevent heavy metal poisoning (such as lead).
Complication
Complications of acute cerebellar ataxia in children Complications
Movement disorders, can not stand, walk, etc., often accompanied by dysarthria, poor eyesight and strabismus eyelids.
1. The dysarthria refers to the weakening of the muscles of the vocal muscles due to the organic damage of the neuromuscular system related to verbal expression, or the changes in muscle tone, poor coordination, etc., resulting in inaccurate pronunciation and uneven rhyme. Speech disorders such as slow flow and rhythm disorder.
Second, the eyeball is poorly distinguished, also known as excessive movement.
(1) The paralyzed patient's upper limbs are lifted forward and hand-rotated, and then the hand is rotated from the supination position.
(2) The patient's upper limbs are lifted forward and palms down. The examiner slams his upper limbs by hand, and the upper limbs of one side are swung up and down.
(3) Line drawing test. The paralyzed patient draws a line between the two lines pre-drawn on the paper, showing that the line drawn far exceeds the limit.
(4) When a patient takes something, it can be seen that the hand is too large to open, which is not commensurate with the size of the object, and the distance is not accurate. It is often overturned before the object can be grasped.
One of the above phenomena is the bad sign.
Symptom
Acute cerebellar ataxia symptoms in children Common symptoms gait instability limb tremor uppercase syndrome ataxia nystagmus tremor intentional tremor dysarthria olfactory brain sensory ataxia gait
The disease is more common in children aged 1 to 4 years old, occasionally seen in children over 10 years old, mainly characterized by ataxia, often accompanied by tremors of the extremities, nystagmus, decreased muscle tone, and decreased sputum reflex.
1. History of pre-infection
About 80% of cases have a history of pre-infection 1 to 3 weeks before the occurrence of ataxia, such as fever, respiratory or digestive symptoms, about 50% of cases have a history of rash infection, some have no pre-infection, in complete health On the basis of ataxia, there are a few cases with ataxia, and rash disease occurs 10 to 20 days later.
2. Onset characteristics
The disease is anxious, starting with the tonic and limbs ataxia, and quickly develops to the peak of symptoms, which is characterized by unstable standing, gait, easy to fall, serious can not stand, can not walk, can not even sit alone , can not be vertical, can not walk with the identification.
3. Physical examination characteristics
Limb ataxia also manifested as instability of the finger test and the knee test, rotation test failure, poor distance and intentional tremor, often accompanied by dysarthria.
The reduction of muscle tone and eyelash reflex is often atypical, muscle strength is normal, sensory examination is normal, brain nerves are not tired, and a small number of sick children have had a pyramidal sign.
Half of the sick children had obvious horizontal nystagmus, and some of the sick children had poor eyeball alignment and strabismus eye spasm.
Examine
Examination of acute cerebellar ataxia in children
First, laboratory inspection
1, cerebrospinal fluid examination
Most cerebrospinal fluids have no obvious abnormalities. A small number of sick children have mild abnormalities in cerebrospinal fluid in the acute phase, such as a slight increase in protein and cells (20 to 60 leukocytes) or an increase in immunoglobulin.
2, pathogen examination
Cerebrospinal fluid in cases where the pathogen is directly infected with brain tissue may have a significant inflammatory response, and the pathogen or corresponding antibody may be found. PCR technology can help identify specific pathogens. Cerebrospinal fluid oligoclonal IgG is often negative. In recent years, cases of cerebellar ataxia after varicella have been found to have demyelinating lesions of the cerebellum.
Second, auxiliary inspection
1. EEG examination is mostly normal. Only some patients have low-density foci in the cerebellar hemisphere. Non-specific changes such as slow wave increase may occur in the acute phase of EEG.
2, brain MRI examination: cerebellar hemisphere can have demyelination changes.
Diagnosis
Diagnosis and diagnosis of acute cerebellar ataxia in children
diagnosis
Mainly based on typical clinical manifestations, the following features are helpful for diagnosis:
1. History of pre-infection.
2. Acute onset.
3. The main manifestation is acute cerebellar ataxia.
4. Except for other neurological disorders: systemic symptoms and other aspects of neurological symptoms are not obvious.
Differential diagnosis
Pay attention to other specific diseases when identifying:
1. Specific neurological infections: such as encephalitis, meningitis, etc., cerebrospinal fluid pathogens can be diagnosed.
2. Drug poisoning: The ataxia caused by drug poisoning is seen in an overdose of antiepileptic drugs such as phenytoin. According to the medical history and the determination of the drug concentration in the blood, the diagnosis can be assisted. If the drug is stopped, the symptoms disappear.
3. Congenital metabolic abnormalities: Ataxia caused by congenital metabolic abnormalities occur repeatedly, such as hyperammonemia, abnormal tryptophan transport, etc., according to family history, metabolic characteristics, mental retardation and other diagnostics, acquired metabolic abnormalities Such as hypoglycemia, low blood sodium, etc., can also cause acute cerebellar ataxia.
4. Posterior cranial fossa lesions: such as tumors, abscesses, hematoma, etc., sometimes manifested as acute cerebellar symptoms, can be identified according to imaging examination, increased intracranial pressure and other symptoms.
5. Hereditary dominant ataxia: It is also possible to repeat acute symptoms, which can be identified according to family history and course of disease.
6. Infectious polyradiculitis or multiple sclerosis: can also be manifested as acute or transient ataxia.
7. Others: hypoglycemia, hypoxia, craniocerebral trauma, labyrinth disease, etc. should also pay attention to identification, as to the cerebellar degeneration or cerebellar hypoplasia caused by ataxia is chronic or progressive, easy to identify with this disease.
