Cerebellar examination

Causes of acute ataxia:

• Drug/toxin (alcohol, phenytoin, piperazine neuroleptics, pesticides)
• Head injury
• Infection (coxsackie, echo, influenza)
• Lesion (infarct, tumour, abscess, bleed)
• Cerebral tumours e.g. brainstem, hydrocephalus, Arnold Chiari malformation
• Hypoglycemia
• Labyrinthitis
• Vitamin E and zinc deficiency

Causes of episodic ataxia:

• Basillar artery migraine
• Seizures
• Metabolic - MSUD; porphyria; Hartnup disease; urea cycle disorders

Causes of chronic ataxia:

• Ataxic cerebral palsy (10% of all cerebral palsy)
• Degnerative - Friedreich ataxia, AT, Wilson, Refsum, Batten, metachromatic leukodystrophy
• Neoplastic - astrocytoma, medulloblast (opsiclonus myoclonus), haemangioblastoma of cerebellum
• Other: hypothyroid, multiple sclerosis (rare in childhood), abetalipoproteinaemia