Neurology
Isolated ataxia in a child is most likely post infectious acute cerebellar ataxia, which results
from an autoimmune-mediated inflammation of the cerebellum due to preceding viral illness,
most common Varicella. They have an excellent prognosis, with the vast majority recovering
without intervention over the course of a few weeks. No interventions are suggested.

Other differentials are posterior fossa tumors, Intoxication, GBS, vertigo due to labyrinthitis.
Seizure activity caused by hypocalcemia will not be responsive to antiepileptic drugs such as
midazolam, lorazepam, or fosphenytoin. Treat with calcium gluconate or calcium chloride.

Hypocalcemia can also present at Tetany and Arrhythmia.
Ataxia
Hypocalcemic Seizure
Cyanotic breath-holding spells are more common than the pallid form and occur when the
child becomes upset following a mild trauma, scolding, or fright.
There is loud crying, followed by prolonged expiratory apnea and cyanosis secondary to
intrapulmonary shunting.
This is followed by limpness and loss of consciousness. The degree of cyanosis and
limpness can be quite pronounced and there may be posturing or less frequently tonic-clonic
movements.
Patients usually regain consciousness fairly rapidly. Some patients may have repeated
episodes, even occurring several times per day.

The
pallid variety is less common and is more frequently confused with a seizure. The etiology
of these events is felt to be due to
vagal mediated bradycardia.
They occur after a sudden usually trivial injury or frustrating event, often a minor head injury.
The provoking event may not be witnessed or recognized, as there can be up to a 30-second
delay in the onset of symptoms.
There is rapid loss of consciousness, pallor, and limp muscle tone with minimal or no crying,
and it may be accompanied with incontinence and clonic movements of the extremities. The
entire event lasts less than 1 minute, but this may be followed by sleepiness or confusion.

An electrocardiogram should be considered for first-time breath-holding spells to evaluate for
long QT syndrome or other arrhythmias.
There is association between breath-holding spells and iron deficiency anemia.
An electroencephalogram could be obtained in patients with atypical spells or prolonged
seizure-like activity.
Breath Holding Spells
Spinal shock
more of a spinal contusion
flaccidity and loss of reflexes after spinal cord injury

Neurogenic Shock
distributive shock
HYPOTENTION AND BRADYCARDIA
Impairment of descending sympathetic pathways in the spinal cord
Loss of vasomotor tone
Treatment- Atropine for bradycardia- IVF and NE for hypotension
Spinal and Neurogenic Shock
Central Cord:
Loss: Motor deficit worse in UE > LE, hands worse than arms
    Preserved: sacral sparing

Anterior:
Loss: LCT (Motor) LST (pain, temperature)
    Preserved DC (proprioception and vibratory sense)

Brown Sequard Loss:
Ipsilateral deficit: LCS (Motor) DC (proprioception/vibration)
                      Contralateral deficits: LST (pain and temperature)

Posterior:
Loss: DC (proprioception)
    Preserved: Motor, pain, light touch
Spinal Cord Injury
Involuntary movements, coordination difficulties, emotional lability, jerky speech.

A poststreptococcal disease and may occur months after the primary bacterial infection. One
of the major diagnostic criteria for rheumatic fever.

Involuntary movements  may be exacerbated by stress and disappears during sleep.

MIlkmaid and Jack in Box Sign

ASO should be ordered. May be absent in 25%.

Chronic prophylactic antibiotics to prevent further beta-hemolytic streptococcus infections;
there is a considerable risk for reoccurrence of rheumatic fever.

Rx - Prednisone and Haloperidol, IV immunoglobulin and plasmapheresis in refractory cases.
Sydenham Chorea