CASE 6570 Published on 20.03.2008
0

Acute cerebellitis

Section

Neuroradiology

Case Type

Clinical Cases

Authors

Alex Rovira, Cristina Auger

Connected authors
Patient

24 years, male

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Clinical History
2-week history of progressive headache associated with ataxic gait.
Imaging Findings
A 24-year-old man, previously in good health, was referred to the emergency department with a 2-week history of progressive headache. He developed intermittent diplopia, dysarthria and ataxic gait. Funduscopy revealed bilateral papilledema. Serological tests were negative. CSF analysis showed an elevated protein content. Brain CT was performed in the emergency room, and 2 days later, brain MRI was carried out.
Discussion
Acute cerebellitis is a rare inflammatory syndrome characterized by cerebellar dysfunction. Most common presenting symptoms include truncal ataxia, dysmetria and headache. It typically occurs as a primary infectious, post-infectious or post-vaccination disorder and mainly presents in childhood and young adulthood. It is usually a benign, self-limiting disease; however, it can end in sudden death or give rise to severe atrophy. Varicella, measles, mumps and rubella are the most common etiologic infectious agents described in children. In most cases, a definite etiology remains undetermined. Serology is usually negative and CSF analysis shows elevated protein content and leukocytes. Brain CT is particularly useful in the acute phase, to detect acute hydrocephalus, cerebellar edema and brainstem compression. MRI is more sensitive and demonstrates increased cerebellar signal intensity on T2-weighted images and swelling. Pial enhancement is observed in some cases. These MR abnormalities most likely reflect the inflammatory nature of this syndrome. Resolution of the clinical symptoms is accompanied by normalization of the cerebellar MRI abnormalities, although development of cerebellar atrophy has been described. In the majority of cases, the treatment for acute cerebellitis is symptomatic, even in cases where no infectious agent can be identified. In some cases involving severe hydrocephalus, ventriculostomy or posterior fossa decompression may be required.
Differential Diagnosis List
Acute cerebellitis
Final Diagnosis
Acute cerebellitis
Case information
URL: https://www.eurorad.org/case/6570
DOI: 10.1594/EURORAD/CASE.6570
ISSN: 1563-4086
Figure 1

Initial (upper row) and fFollow-up CT (lower row) obtained six days later

Initial (upper row) and fFollow-up CT (lower row) obtained six days later
Initial brain CT (upper row) shows slightly hyperdense cerebellar parenchyma. Follow-up CT (lower row) obtained six days later demonstrates cerebellar cortical swelling with a small fourth ventricle, and obliterated basal cisterns. Mild supratentorial hydrocephalus is also seen.
Figure 2

Brain MR obtained on the 8th day after admission.

Brain MR obtained on the 8th day after admission.
Axial and coronal T2-weighted images show marked abnormal areas of increased signal intensity in both cerebellar hemispheres and vermes.
Brain MR obtained on the 8th day after admission.
Unenhanced (left) and contrast-enhanced (right) sagittal T1-weighted images show cerebellar cortical swelling with a small fourth ventricle and basal cisterns, and no pathological contrast uptake.
Figure 3

Follow-up brain MRI obtained on the 15th day after admission.

Follow-up brain MRI obtained on the 15th day after admission.
Axial T2-weighted images show reversal of the abnormal signal intensity and swelling.
Follow-up brain MRI obtained on the 15th day after admission.
Sagittal T1-weigthed image show reversal of the cerebellar swelling.