BACKGROUND: Acute cerebellar ataxia is a clinical syndrome with sudden onset of uncoordinated gait and normal mental status in young children. Although it has a benign clinical course, it often requires an exhaustive diagnostic work-up in order to rule out potentially life-threatening etiologies that present similarly. The wide differential encompasses causes from infections, brain masses, drugs, toxins, trauma, paraneoplastic syndromes, as well as hereditary or congenital disorders.

CASE REPORT: We report on a 4-year-old boy with recent hand-foot-mouth disease who presented with acute cerebellar ataxia. In addition to his marked truncal ataxia and wide-based, staggering gait, he had slowness of speech, which is not commonly reported with this condition in the literature. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians have a unique role in being first to evaluate pediatric ataxia and can make a significant impact on identifying potentially fatal mimickers of acute cerebellar ataxia. This article will attempt to outline major diagnostic considerations in order to aid emergency physicians through their clinical approach.