Atormac
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 1739  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (507 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this Article
   References

 Article Access Statistics
    Viewed1106    
    Printed15    
    Emailed0    
    PDF Downloaded34    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents    
LETTER TO EDITOR
Year : 2017  |  Volume : 65  |  Issue : 5  |  Page : 1137-1138

Acute hemicerebellitis in children: A report and literature review


1 Department of Pediatrics, Pediatric Neurology Unit, Mansoura University, Mansoura, Egypt
2 Department of Psychiatry, Beni-Suef University, Beni-Suef City, Egypt

Date of Web Publication6-Sep-2017

Correspondence Address:
Riad M Elsayed
Department of Pediatrics, Pediatric Neurology Unit, Mansoura University, Mansoura
Egypt
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/neuroindia.NI_1289_15

Rights and Permissions



How to cite this article:
Elsayed RM, Sayyah HE. Acute hemicerebellitis in children: A report and literature review. Neurol India 2017;65:1137-8

How to cite this URL:
Elsayed RM, Sayyah HE. Acute hemicerebellitis in children: A report and literature review. Neurol India [serial online] 2017 [cited 2019 Sep 16];65:1137-8. Available from: http://www.neurologyindia.com/text.asp?2017/65/5/1137/214039


Sir,

Acute cerebellitis, a typically bilateral and symmetric disease, is an inflammatory process commonly involving both cerebellar hemispheres. Acute hemicerebellitis in children may have a rare unilateral presentation of cerebellitis, as well as undefined etiology and outcome. We report a case of hemicerebellitis, focusing on the clinical presentation and outcome.

A 7-year old girl was admitted to the hospital with a history of severe headache and vomiting of sudden onset, a week before admission, along with a low-grade fever reported by her parents. Her personal and family history were unremarkable, and there was no recent history of viral illness or administration of a vaccination. She was not on any medication. No abnormalities were found at the initial physical examination, and there were no signs of meningeal irritation; however, the child was hallucinating and confused. Her blood chemistry was normal. Her cerebrospinal fluid (CSF) collected by a lumbar puncture revealed a normal chemistry. The cytology of the CSF revealed reactive mesothelial cells and was negative for bacteria. Intravenous hydration and analgesic were prescribed in the emergency room, and the initial non-enhanced computed tomography (CT) scan was normal. Intravenous acyclovir was started considering the possibility of acute encephalitis; however, the child deteriorated with the occurrence of recurrent episodes of projectile vomiting, severe headache, confusion, hallucination, agitation, and intense fear. Manifestations of cerebellar involvement started to appear in the form of ataxia and slurred speech. Magnetic resonance imaging (MRI) of the brain performed after 2 days revealed a left-sided hemicerebellitis. Its management included fluid restriction, intravenous steroids, and conventional antipsychotic medications, prescribed by the psychiatrist, until the resolution of the acute symptoms occurred in almost a week's time. Complete remission of the symptoms was achieved within 3 weeks. At follow-up visit at the outpatient clinic, the patient had complete recovery without any residual manifestations.

Acute cerebellitis is considered as an inflammatory syndrome and is clinically defined to be causing fever, nausea, headache, and an altered mental status in conjunction with acute onset of cerebellar symptoms.[1],[2] The clinical signs of cerebellitis are usually bilateral and symmetrical.[3] Acute hemicerebellitis in childhood has an extremely rare unilateral presentation of cerebellitis mimicking a tumor.[4],[5] Its etiology is usually viral and a large number of viruses have been implicated (varicella-zoster, measles, mumps, coxsackie, Epstein-Barr, rubella, pertussis, diphtheria, among others), although in most cases, a definite etiology remains undetermined.[6],[7] Furthermore, acute cerebellitis is characterized by CSF pleocytosis and/or neuroradiological evidence of inflammation, such as cerebellar swelling.[8],[9] Acute hemicerebellitis was diagnosed in our patient on the basis of clinical symptoms and laboratory findings, including a low-grade fever, severe headache, and mild CSF changes. MRI of the brain in our patient revealed an increased signal intensity along with focal lesions of the left cerebellar cortex. Unilateral involvement in cerebellitis (hemicerebellitis) is very rare and has been previously reported in a few cases,[3],[4],[5],[10],[11],[12],[13],[14] with the imaging revealing unilateral findings similar to that seen in the classic bihemispheric cerebellitis in most cases, except for the pure unilateral involvement. The reasons for the unilateral involvement are unknown. Our patient experienced severe headache, confusion, hallucination, agitation, and intense fear, which necessitated a psychiatric consultation. Most of the symptoms were relieved by the conventional antipsychotic drugs. Clinical improvement and complete recovery occurred after 3 weeks of treatment. It is reported that the clinical outcome is generally good and has a self-limited evolution, even in the absence of specific treatment. MRI findings may be misunderstood leading to an erroneous diagnosis and invasive treatment. Clinical improvement and regression of the pathological findings on serial MRI can help to differentiate acute hemicerebellitis from a neoplastic process.[4] Our patient came for follow-up after 6 months with a complete recovery. Some articles have, however, reported a near fatal course or even a mortality,[5] and others have reported a residual cerebellar atrophy.[3]

In this report, a rare neuropsychiatric disorder (hemicerebellitis) is presented where the unilateral radiological manifestations may have led to a diagnostic dilemma.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Sawaishi Y, Takada G. Acute cerebellitis. Cerebellum 2002;1:223-8.  Back to cited text no. 1
    
2.
Horowitz MB, Pang D, Hirsh W. Acute cerebellitis: Case report and review. Pediatr Neurosurg 1991–1992;17:142-5.  Back to cited text no. 2
    
3.
Sékhara T, Christophe C, Christiaens F, Dan B. Postinfectious hemicerebellitis. Rev Neurol (Paris) 2001;157:84-6.  Back to cited text no. 3
    
4.
Rodríguez-Cruz PM, Janet-Signoret S, Miranda-Herrero MC, Barredo-Valderrama E, Vázquez-López M, Ruiz-Martín Y, et al. Acute hemicerebellitis in children: Case report and review of literature. Eur J Paediatr Neurol 2013;17:447-53.  Back to cited text no. 4
    
5.
Morais RB, Sousa I, Leiria MJ, Marques C, Ferreira JC, Cabral P. Pseudotumoral acute hemicerebellitis in a child. Eur J Paediatr Neurol 2013;17:204-7.  Back to cited text no. 5
    
6.
Montenegro MA, Santos SL, Li LM, Cendes F. Neuroimaging of acute cerebellitis. J Neuroimaging 2002;12:72-4.  Back to cited text no. 6
    
7.
De Bruecker Y, Claus F, Demaerel P, Ballaux F, Sciot R, Lagae L, et al. MRI findings in acute cerebellitis. Eur Radiol 2004;14:1478-83.  Back to cited text no. 7
    
8.
Bakshi R, Bates VE, Kinkel PR, Mechtler LL, Kinkel WR. Magnetic resonance imaging findings in acute cerebellitis. Clin Imaging 1998;22:79-85.  Back to cited text no. 8
    
9.
Montenegro MA, Santos SL, Li LM, Cendes F. Neuroimaging of acute cerebellitis. J Neuroimaging 2002;12:72-4.  Back to cited text no. 9
    
10.
Garcia-Cazorla A, Olivan JA, Pancho C, Sans A, Boix C, Campistol J. Infectious acute hemicerebellitis. J Child Neurol 2004;19:390-2.  Back to cited text no. 10
    
11.
Usano A, Torres J, Jadraque R, Avilla JM, Collado E. Acute unilateral cerebellar ataxia: A case report. Rev Neurol 2000;30:698-9.  Back to cited text no. 11
    
12.
Jabbour P, Samaha E, Abi Lahoud G, Koussa S, Abadjian G, Nohra G, et al. Hemicerebellitis mimicking a tumour on MRI. Childs Nerv Syst 2003;19:122-5.  Back to cited text no. 12
    
13.
Iester A, Alpigiani MG, Franzone G, Cohen A, Puleo MG, Tortori-Donati P. Magnetic resonance imaging in right hemisphere cerebellitis associated with homolateral hemiparesis. Childs Nerv Syst 1995;11:118-20.  Back to cited text no. 13
    
14.
Omeis IA, Khoshyomn S, Braff SP, Maugans TA. Idiopathic lymphocytic cerebellitis. Pediatr Neurosurg 2002;36:52-3.  Back to cited text no. 14
    




 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow