Acute cerebellitis in children: A series of eight cases

Abstract

Objective: Acute cerebellitis is a rare condition often characterized by severe headache, vomiting, fever, ataxia and loss of consciousness. Its course is usually self-limited but occasionally fulminant. Differentiation of acute infectious cerebellitis from postinfectious cerebellitis is usually based on the presence of fever and absence of a latent period following a non-specific infection. Methods: We present clinical and paraclinical findings, treatment and outcome data of eight children diagnosed with acute cerebellitis in our department between 2010-2016. Results: There were 5 girls and 3 boys aged 3-16.5 years, median 8 years. Main presenting symptoms were headache, fever, vomiting and ataxia. Most common MR imaging finding at presentation was bilateral, diffuse signal changes in cerebellar hemispheres. Two patients had hydrocephalus, one had herniation, and one, both hydrocephalus and herniation. Etiological work-up for infectious pathogens revealed mycoplasma pneumoniae and influenza virus in one case each. Two cases underwent lumbar puncture: one was normal, the other showed elevated protein and low glucose. Treatment included steroids in all cases, acyclovir in 7, antibiotics in 2, intravenous immunoglobulins in 1, oseltamivir in one case. No patients required surgery for hydrocephalus or herniation. Four patients had full recovery and four had residual neurologic deficits consisting in cerebellar tremor and ataxia (n=3) and cognitive deficit (n=2). Patients with neurological sequalae had cerebellar atrophic changes on follow-up MRI. Patients admitted >7 days after symptom onset recovered with sequalae while those admitted<3 days showed complete recovery. Conclusion: There were no fatalities in this series of acute cerebellitis, suggesting early diagnosis and treatment can increase the chance of uneventful recovery.