WordNet

of critical importance and consequence; "an acute (or critical) lack of research funds"
having or demonstrating ability to recognize or draw fine distinctions; "an acute observer of politics and politicians"; "incisive comments"; "icy knifelike reasoning"; "as sharp and incisive as the stroke of a fang"; "penetrating insight"; "frequent penetrative observations" (同)discriminating, incisive, keen, knifelike, penetrating, penetrative, piercing, sharp
extremely sharp or intense; "acute pain"; "felt acute annoyance"; "intense itching and burning" (同)intense
having or experiencing a rapid onset and short but severe course; "acute appendicitis"; "the acute phase of the illness"; "acute patients"
of an angle; less than 90 degrees
inability to coordinate voluntary muscle movements; unsteady movements and staggering gait (同)ataxy, dyssynergia, motor_ataxia
relating to or associated with the cerebellum; "cerebellar artery"

PrepTutorEJDIC

(先の)『鋭い』,とがった / (痛み・感情などが)『激しい』,強い / (知力・感覚などが)『鋭い』,鋭敏な / (事態が)重大な / (病気が)急性の / (音が)高い,鋭い / 鋭角の

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/04/16 22:34:49」(JST)

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Acute cerebellar ataxia of childhood is a childhood condition characterized by an unsteady gait, most likely secondary to an autoimmune of postinfectious cause, drug induced or paraneoplastic.^[1] Most common virus causing acute cerebellar ataxia are Chickenpox virus and Epstein Barr Virus. It is a diagnosis of exclusion

Epidemiology

Acute cerebellar ataxia is the most common cause of unsteady gait in children. The condition is rare in children older than ten years of age. Most commonly acute cerebellar ataxia affects children between age 18 mo and 7 years.

Etiology

Most common cause of acute cerebellar ataxia is varicella infection. Other viruses include influenza, Epstein-Barr virus, Coxsackie virus, Echo virus or mycoplasma. The possible mechanism is immune complex deposition in the cerebellum.

Clinical features

Acute cerebellar ataxia usually follows 2–3 weeks after an infection. Onset is abrupt. Vomiting may be present at the onset but fever and nuchal rigidity charecterestically are absent. Horizontal nystagmus is present is approxiamtely 50% cases.

Truncal ataxia with deterioration of gait
Slurred speech and nystagmus
Afebrile

Diagnosis

Acute Cerebellar ataxia is a diagnosis of exclusion. Urgent CT scan is necessary to rule out cerebellar tumor or hemorrhage as cause of the ataxia; however in acute cerebellar ataxia, the CT will be normal. CSF studies are normal earlier in the course of disease. Later on CSF shows moderate elevation of proteins.

Management

Supportive treatment is the only intervention for acute cerebellar ataxia of childhood. Symptoms may last as long as 2 or 3 months.

Differential Diagnosis

Brain tumors, including cerebellar astrocytoma, medulloblastoma, neuroblastoma
Cerebellar contusion
Subdural hematoma
Toxins, including ethanol or anticonvulsants
Cerebellar infarction or hemorrhage
Meningitis
Encephalitis
Acute disseminated encephalomyelitis
Multiple sclerosis

References

^ Brown, Miller. "Pediatrics." Lipincott Williams and Wilkins, 2005, pp 380.

See Also http://www.nlm.nih.gov/medlineplus/ency/article/001397.htm

UpToDate Contents

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1. 小児における急性小脳性運動失調 acute cerebellar ataxia in children
2. 急性運動失調を呈する小児に対するアプローチ approach to the child with acute ataxia
3. 成人における小脳性運動失調の概要 overview of cerebellar ataxia in adults
4. 水痘帯状疱疹ウイルス感染の臨床的特徴：水痘 clinical features of varicella zoster virus infection chickenpox
5. 眼球クローヌス・ミオクローヌス運動失調 opsoclonus myoclonus ataxia

English Journal

Assessing the efficacy of specific cerebellomodulatory drugs for use as therapy for spinocerebellar ataxia type 1.

Nag N, Tarlac V, Storey E.SourceVan Cleef Roet Centre for Nervous Diseases, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, 3004, Australia.
Cerebellum (London, England).Cerebellum.2013 Feb;12(1):74-82. doi: 10.1007/s12311-012-0399-x.
Spinocerebellar ataxias are autosomal dominant diseases, associated in some types with a CAG repeat expansion, and characterised by a progressive loss of motor function. Currently, as there is no cure for most ataxias, treatment predominantly involves physical therapy. Various symptomatic drug treat
PMID 22718440

Walking unsteadily: a case of acute cerebellar ataxia.

Simonetta F, Christou F, Vandoni RE, Nierle T.SourceDepartment of Internal Medicine, Hôpital du Jura bernois SA, Moutier, Switzerland.
BMJ case reports.BMJ Case Rep.2013 Jan 2;2013. pii: bcr2012007688. doi: 10.1136/bcr-2012-007688.
Acute cerebellar ataxia is an infrequent neurological syndrome in adults especially if complicated by additional neurological deficits. We report the case of a 69-year-old woman who presented with sudden onset of left facial droop, dizziness, slurred speech and impaired balance. Her medical history
PMID 23283615

Clinical association of intrathecal and mirrored oligoclonal bands in paediatric neurology.

Sinclair AJ, Wienholt L, Tantsis E, Brilot F, Dale RC.SourceDepartment of Child Neurology, Sydney Children's Hospital, Sydney; Immunology laboratory, Royal Prince Alfred Hospital, Sydney; Neuroimmunology Group, Institute for Neuroscience and Muscle Research, the Children's Hospital at Westmead, University of Sydney, Australia.
Developmental medicine and child neurology.Dev Med Child Neurol.2013 Jan;55(1):71-5. doi: 10.1111/j.1469-8749.2012.04443.x. Epub 2012 Oct 24.
Aim Biomarkers such as autoantibodies, neopterin, and oligoclonal bands (OCBs) are increasingly used for the diagnosis of treatable inflammatory central nervous system (CNS) disorders. We investigated the correlation between the results of OCB testing and clinical diagnoses in a large contemporar
PMID 23095051

Japanese Journal

経過良好な、マイコプラズマ感染症関連Opsoclonus-Myoclonus症候群の1例

河野香,伊藤康,石塚喜世伸,西川愛子,佐原真澄,平野嘉子,石垣景子,舟塚真,高橋幸利,大澤眞木子
東京女子医科大学雑誌 83(E1), E336-E341, 2013-01-31
Opsoclonus-myoclonus syndrome(OMS)は,左右共同性の不規則で多方向性の異常眼球運動,顔面,頭部,体幹などに出現するmyoclonus,小脳失調を特徴とする症候群である.小児において,腫瘍,感染,予防接種などが誘因となり,半数に神経芽細胞腫を合併する.症例は4歳9ヵ月の女児.生後11ヵ月時にマイコプラズマ感染を契機にOMSを発症した.血清マイコプラズマ抗体価(PA法) …
NAID 110009559410

アルコール依存症とWernicke's encephalopathy(<特集>ビタミンB_1による認知症の予防・治療)

松井敏史,櫻井秀樹,遠山朋海 [他],吉村淳,松下幸生,樋口進
ビタミン 86(11), 630-635, 2012-11-25
… Wernicke's encephalopathy (WE) is the best known acute neurologic complication of vitamin B_1 (B_1) deficiency and often occurs in chronic alcoholism. … The Caine criteria include dietary deficiency, oculomotor abnormalities, cerebellar dysfunction and either altered mental status or mild memory impairment, two of which are required for diagnosis of clinical WE. …
NAID 110009554187

急性前庭障害と誤った小脳梗塞の2例

晝間清,沼田勉
耳鼻咽喉科臨床 105(10), 919-923, 2012-10-01
… We report on two cases of cerebellar infarction which were thought to be examples of acute vestibular disorder before being diagnosed with MRI. … After that, MRI was performed and showed cerebellar vermis infarction without brain stem involvement which was thought to be in the PICA (posterior inferior cerebellar artery) area. …
NAID 10031117854

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