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2019

ANUÁRIO DO HOSPITAL
DONA ESTEFÂNIA

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ACUTE ATAXIA AS RESULT OF ACUTE LABYRINTHITIS IN THE CONTEXT OF OTOMASTOIDITIS AND OTITIS MEDIA

Lia Mano1, Inês Moreira2, Ana Isabel Dias3, Maria João Brito1

1 - Pediatric Infectious Diseases Unit
2 - Otorhinolaryngology Unit
3 - Pediatric Neurology Unit

Hospital Dona Estefânia – CHLC - EPE, Lisbon, Portugal. 
Head of Department: Gonçalo Cordeiro Ferreira

- European Society for Paediatric Infectious Diseases, 2016, 10-14 May, Brighton, UK (Poster)

Introduction: Assessing a child who presents with ataxia can be challenging. Acute ataxia is not common in pediatric age. Central causes as cerebelous ataxia and post-infectious acute cerebelitis are the most commonly mentioned. Periferic vestibulopathies, as vestibular neuritis and labyrinthitis are rare etiologies. They are frequently related with superior airways inflammatory processes of viral etiology.
Case: A previously healthy 3-year-old girl, with maternal antecedents of febrile convulsions and a paternal great-aunt with epilepsy, had a first episode of febrile tonic-clonic convulsion. Posteriorly she initiated irritability, prostration and ataxia with imbalanced and wide step gait, without meningeal signs. In the previous 5 days she present with rhinofaringitis and 37,5ºC. She had acute otitis media of the right ear and left seromucous otitis of the left ear. CTH revealed findings of bilateral otomastoiditis and ethmoid and maxillary sinusopathy. Lumbar puncture was normal. Toxicologic analysis was negative. Magnetic resonance imaging revealed importante obliteration of mastoid air cells and tympanic cavity in relation to sinusoidal and ear inflammation. No alterations of cerebral parenchima, cerebellum and brainstem were revealed. Head impulse test and head shaking test caused discomfort bilaterally, without nistagmus. Tympanogram was bilaterally flat. Vestibular neuritis was admitted. She received ceftriaxone and amoxicilin and clavulanate after discharge, neo-synephrine and topic nasal corticoid. Ataxia and vertigo reverted totally after 48 hours of therapy. Surgery will be further considered (venttube tyampanostomy).
Conclusions: Periferic vestibulopathy in the toddler is an entity difficult to diagnosis, for the subjectivity of clinical signs and symptoms, which implies a high suspicion índex. Diagnosis is usually clinic with acute onset of vertigo associated with náusea, vomits and gait alterations. It usually presents a benign and auto-limited course from days to weeks.

Palavras-chave: ataxia, labyrinthitis, otomastoiditis, otitis media