Abstract. Cerebellar disorders due to herpes simplex virus (HSV) infection are rare and always associated with herpes simplex encephalitis. We report 2 cases . This article includes discussion of acute cerebellar ataxia (in children), acute cerebellitis, and acute postinfectious cerebellitis. The foregoing. Acute cerebellar ataxia is a syndrome that occurs in previously well children, often presenting Acute cerebellar ataxia, acute cerebellitis, and.
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Acute cerebellitis AC and acute cerebellar ataxia ACA are the principal causes of acute cerebellar dysfunction in childhood. Severity was divided in three classes: A total of children were included in the study. Other common symptoms included balance disturbances, slurred speech, vomiting, headache and fever. Children with pathological magnetic resonance imaging MRI or computed tomography CT had a higher probability of having clinical sequelae.
Treatment was decided independently case by case. Patients with a higher clinical score on admission had a higher probability of receiving intravenous steroids. These patients may benefit from a more aggressive therapeutic strategy and should have a closer follow-up. Randomized controlled trials are needed to confirm these observations. Because of similarities in the clinical presentation, ACA and AC are regarded by some authors as a continuum with similar pathogenesis [ 3 ].
Cases were identified by reviewing hospital charts of all children admitted for signs or symptoms indicative of acute cerebellitis.
In each case, the following data were collected: Acute sickness due to cerebellar symptoms can mimic behavioural changes, but this was assessed only by the clinician not on a subjective parental account. Symptoms at disease manifestation were divided into cerebellar symptoms and extracerebellar symptoms as in Fig. Demographic, clinical, laboratory and microbiological data, neurologic investigations, radiologic studies and treatments, outcome and instrumental findings at follow-up were registered.
Severity was divided in three classes Fig. Follow-up was performed according to the local experience of each center.
Follow-up included clinical, neurological and cognitive evaluation; neuroimaging was performed when the local clinician considered it worthwile. Categorical data were given as number of cases and percentages, continuous variables were reported as median and range. Chi-square test or Fisher exact test were performed to assess association between categorical variables, while Mann-Whitney test were used for quantitative variables.
Six children, 5 boys and 1 girl, aged 2. Routine laboratory findings were normal in all children. Clinical presentation was similar in all cases except cases 1 and 2, who presented headache and behavioral changes in addition to their cerebellar symptoms. These were the only two children who underwent a computed tomography CT scan with pathological findings and the only two children with neurological sequelae.
Tone, deep tendon reflexes and plantar responses were normal in all patients.
If you are walking, you might suddenly feel as if you are tipping over. Everyone had at least one cerebellar symptom. The cerebrospinal fluid CSF glucose was normal in all cerebeellitis. A definitive microbiological diagnosis was obtained in 2 cases by positive PCR on cerebrospinal fluid VZV and parainfluenzae virus. Main findings slow bilateral activity in the occipital regions.
VZV was diagnosed on a clinical basis since sierological tests to confirm Chickenpox are not necessary. All patients presented cerevellitis cerebellar symptoms either on the crusted phase or in any case not before day 5 of the disease. Clinical presentation and outcome did not changed based on the day of the disease. Median follow-up time was 1 year. No cognitive function nor behavioral changes were noted.
Similarly, a pathological CT on admission was strongly associated with neurological sequelae P 0. The hospitalization of our patients was longer than those reported in the literature 6.
Neurological presentation was also often characterized by dysmetry and difficult speech.
Acute cerebellitis in children: an eleven year retrospective multicentric study in Italy
In the literature one of the most detailed descriptions of the clinical presentation for VZV- related cerebellitis showed similar findings [ 17 ]. Brain MRI was performed in half of cases The possibility of various patterns of cerebellar involvement in AC have been already reported [ 3 ] and our findings are similar to those described. MRI brain after administration of mdc nuanced impregnation of the meninges in the cerebellar lobe in some places shows micro nodular appearance case 4.
These findings may acutr a clinical consequence since these patients could be those selected for steroid therapy, even though currently there are no data in literature to suggest this strategy. Nevertheless, the potential utility of brain CT in the acute phase, to detect acute hydrocephalus, cerebellar edema or brainstem compression has already been proposed since a few cases of AC [ 3 ], with hydrocephalus as the presenting symptom, have been described in the literature [ 18 — 20 ].
This delay could explain the low number of pathological MRI we found in this series and therefore some cases of AC may have been missed because of this. Similarly, most authors use steroids, mainly for more complicated cases [ 131728 ], but it is not clear what is meant by more severe cases and which is the best steroid, dosage, mode of administration and length of therapy. In any case, since we demonstrated cerebellitid children with pathological brain CT or MRI on admission had a higher probability of acure long-term neurological sequelae, this sub-set of patients could be the ecrebellitis to select for early and more aggressive treatment.
In literature we found other reports which describe infection of VZV and neurological complication encephalitis, meningitis, cerebellitis, poliradiculopaty, transverse cerfbellitis in adults and children [ 343031 ]. Other reports describe Acute ataxia in Acjte but they analyzed a different pathogenesis, not only infectious and post infectious AC [ 3233 ]. However only the report cited in our work matched properly with our criteria ie AC in children with Varicella.
Moreover the report of Bozzola et al. This subset of children did not have a different severity at presentation nor a different outcome. This finding is of interest if we consider VZV immunization policies cerebellitiis Italy, where since only a few Italian Regions have had coverage and it is still very low in most of the other Italian Regions.
This cerebellitsi highlights the potential benefits of spreading VZV vaccinations since the prevention of disease may also reduce the complications of VZV infection. In our series, 6 children presented neurological sequelae ataxia in 3 cases, balance disturbances and dysarthria in 1 case, ataxia and balance disturbances in 1 case and ataxia and hypotonia in 1 case. It is of note that this study included mainly children without mental acut changes and normal imaging studies.
On the cerebeliltis, Hennes et al. Studies exploring clinical data able to predict neuroimaging abnormalities could be useful in this selection.
Unfortunately in our study we did not find any clinical presentation associated with abnormal neuroimaging studies. The main limits of this study are the retrospective nature and the lack of neuroimaging follow-up for those with baseline pathological CT-MRI.
So we analyzed all the data in order to find the risk factors and the early predictive signs of adverse outcome but such evaluation did not show a correlation between sequelae and clinical manifestations or therapeutic strategies, or CSF findings. The only statistically significant association was found between pathological MRI or CT images at admission and the neurological sequelae, in addition to a relationship between the severity of clinical manifestations and a pathological CT.
All authors read and approved the final version.
Post viral cerebellar ataxia – Wikipedia
Springer Nature cerebrllitis neutral with regard to jurisdictional claims in published maps and institutional affiliations. Maria Luisa Galli, Email: Guido Castelli Gattinara, Email: Maria Di Gangi, Email: Maria Luisa Derebellitis, Email: National Center for Biotechnology InformationU.
Journal List Ital J Pediatr v. Published online Jun Author information Article notes Copyright and License information Disclaimer. Received Oct 18; Wcute May This article has been cited by other articles in PMC. Abstract Background Acute cerebellitis AC and acute cerebellar ataxia ACA are the principal causes of acute cerebellar dysfunction in childhood.
Results A total of children were included in the study. Cerebellitis, Children, Outcome, Therapy. Table 1 Italian participant centers. Open in a separate window. Statistical Analyses Categorical data were given as number of cases and percentages, continuous variables acuts reported as median and range. Characteristics of patients with AC Six children, 5 boys and 1 girl, aged 2. Table 2 Patients characteristics and outcome. With Sequelae Without Sequelae P. Table 3 Clinical presentation and microbiological results of the 6 children with AC.
Case Age yearsSex Aetiological diagnosis Clinical findings 1 3. Cerebellar leptomeningeal enhancement; CT: Cerebellar leptomeningeal enhancement; Abnormal: Outcome Median follow-up time was 1 year. Competing interests The authors declared that they have no competing interest. Consent for publication Not applicable.
Acute cerebellar ataxia in children
Ethics approval and consent to participate Not applicable. Contributor Acure Laura Lancella, Email: Sawaishi Y, Takada G. Acute cerebellitis presenting as tumor. Report of two cases. J Neurosurg ; 1 Suppl 57— MRI findings in acute cerebellitis. Cerebellar atrophy attributed to cerebellitis in two patients. Magn Reson Med Sci.