Acute cerebellar ataxia and acute cerebellitis in children in a single tertiary medical center

Abstract

Objective: Acute cerebellar ataxia in children can be infectious, postinfectious, or vaccination-related. Most of them have benign courses. However, acute ataxia can be caused by acute cerebellitis, acute disseminated encephalomyelitis, or acute encephalitis. This study is aimed to present our experiences with acute cerebellar ataxia in children, focusing on clinical features, neurologic imagings, and outcomes. Methods: Medical records of the patients whose initial impressions were cerebellar ataxia under the age 18 years from 2012 to October 2016 were reviewed retrospectively. Initially, thirteen subjects were included, but 3 were excluded due to loss of follow-up. Results: A total of 10 subjects were included and six were males (M:F = 1.5:1). All of them showed ataxic gait. Mean age at first visit was 4.3 (1.33 ∼ 9.98) years. Eight subjects had recent fever history, and four were in febrile state on admission. Among nine patients who performed MRI, three revealed abnormal signals on cerebellum. Rhinovirus and stool enterovirus were the most common infectious pathogens. Antibiotics and antiviral agents were used in five patients, steroid in four, mannitol in four, and IVIG in three. In comparison of two groups subdivided by MRI abnormalities, both fever duration (8 ± 6.1 vs. 3.8 ± 2.1 days) and the time to full recovery (19 ± 11.14 vs. 7.86 ± 3.24 days) were longer in the group with MRI abnormality. Acute cerebellar ataxia (n=7) was associated with infectious/postinfectious or vaccination. Among acute cerebellitis (n=3), thalamus (n=1) or spinal cord (n=1) was also involved. Mean follow-up duration was 10.6 (0.23 ∼ 37.2) months. All patients showed co complete recovery, and there was no recurrence. Conclusion: Acute cerebellar ataxia showed fast recovery. MRI is useful for the differential diagnosis of the cerebellar pathology. Although the time to full recovery was longer in acute cerebellitis, all of them showed full recovery.