Magnetic Resonance Imaging Abnormalities in a Child with Acute Cerebellitis.

Abstract

A three-year-old girl was admitted to the Emergency Department of the Sultan Qaboos University Hospital, Muscat, Oman, in August 2014 with a three-day history of an acute unsteady gait. She had had an upper respiratory infection one week prior to admission. There was no history of headaches, vomiting or loss of consciousness, nor a history of similar illnesses in the past or within the patient’s family. On examination, the cranial nerves and optic fundi were normal with no pyramidal signs, nystagmus or opsoclonus. The patient had truncal ataxia, a severe unsteady gait and was not able to walk unsupported. An urgent non-contrast computed tomography scan of the brain revealed a hypoattenuating area involving both cerebellar hemispheres and the vermis, associated with effaced cerebellar and vermis folia. Magnetic resonance imaging (MRI) of the brain showed hyperintense changes in the cerebellar hemispheres and vermis [Figure 1]. The MRI showed evidence of mild diffusion restriction in the lesion. There was no significant enhancement of the lesion after the administration of contrast media and no perilesional oedema was noted. Figure 1A &B: Axial fluid-attenuated inversion recovery magnetic resonance images of the brain of a child with acute cerebellitis showing diffuse hyperintense changes in the cerebellar hemispheres and vermis. Baseline blood investigations, tandem mass spectrometry and lactate and ammonia tests were normal. A lumbar puncture revealed 25 lymphocytes/mm3 with normal glucose and protein levels. Polymerase chain reaction tests of the cerebrospinal fluid were negative for herpes simplex virus, enteroviruses, varicella zoster virus and mumps. The patient was prescribed 30 mg/kg of methylprednisolone once daily for three days followed by 1 mg/kg/day of oral prednisolone for one week which was subsequently tapered over the second week. After treatment, a 10-week follow-up T2-weighted fluid-attenuated inversion recovery MRI brain scan showed complete resolution of the cerebellar and vermis hyperintense lesions. The patient showed remarkable improvement with steroids and had totally recovered within a month.