19 September 2009
ROTAVIRUS AND ACUTE CEREBELLAR ATAXIA
Children with acute cerebellar ataxia present with a disturbed smooth coordination of movements. This self-limited condition is associated with many infectious diseases.1 We present a case of acute ataxia possibly triggered by a rotavirus infection. The patient, a previously healthy 3-year and 3-month-old boy with a 10-day history of fever, vomiting and watery diarrhea, presented with acute gait disturbance. Despite inquiry, no history of drug ingestion could be elicited. On examination the child was well, awake, afebrile, normotensive and alert with no meningeal signs, a normal clinical dehydration scale, absent nystagmus and normal fundoscopy. Muscle strength and deep reflexes were normal with no ankle clonus. However, he was unable to speak, walked unsteadily with a wide-based gait and experienced difficulty when attempting quick or precise movements. Stool was positive for rotavirus antigen. A complete blood count, blood levels of glucose, sodium and potassium in blood, and magnetic resonance neuro-imaging without contrast agent were normal.
Most cases of acute childhood cerebellar ataxia occur between 2 and 9 years of age. The condition is mostly triggered by an infectious agent, including among others varicella zoster virus, mumps virus, Epstein–Barr virus and mycoplasma pneumoniae.1 The isolation of microbial antigens, anti-microbial antibodies or both microbial antigens and anti-microbial antibodies from the cerebrospinal fluid of some patients indicates that acute cerebellar ataxia likely represents a “site-restricted” variant of acute disseminated encephalomyelitis.1
We suggest that in our patient, acute ataxia resulted from the rotavirus infection. Although rotavirus infections are common,2 this neurologic complication has so far been reported in no more than three children aged between 2 years and 7 months and 4 years and 6 months.3,4 Those children, however, had a more severe clinical presentation and took longer to recover.