title: Cerebellar ataxia due to Leptospirosis- a case report.
abstract: BACKGROUND
  Leptospirosis involves nervous system in around 10-15% of the cases, the commonest presentation being aseptic meningitis. Most of the clinical features of neuroleptospirosis are due to capillary endothelial damage and vasculitis. Ataxia is an extremely uncommon manifestation of Leptospirosis occuring in <5% of cases.
  
  
  METHODS
  A 28 year old female from North India presented with a short febrile illness followed by an acute onset cerebellar ataxia, anemia, thrombocytopenia and transaminitis. Leptospira serology showed high titres of IgM (ELISA) and MAT (microscopic agglutination test titre >1:800) . She was treated with intravenous ceftriaxone for 14 days following which she showed marked recovery.
  
  
  CONCLUSIONS
  The clinical features of neuroleptospirosis are varied, most of them resulting from endothelial damage and vasculitis. Immune mediated phenomenon with no structural damage is another possible mechanism leading to cerebellar ataxia. Cerebellar ataxia due to common tropical infections should be ruled out in the appropriate setting, as early institution of treatment can abate neurological morbidity. The case report highlights the importance of identifying a reversible cause of cerebellar ataixa due to a tropical infection, possibly due to a immune mediated phenomenon, and would be of interest to both internists and neurologists.
authors.affiliation: Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Rajveer
authors.initials: R
authors.lastname: Singh
authors.affiliation: Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. dherajk@yahoo.com.
authors.forename: Dheeraj
authors.initials: D
authors.lastname: Khurana
authors.affiliation: Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Sahil
authors.initials: S
authors.lastname: Mehta
authors.affiliation: Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Aditya
authors.initials: A
authors.lastname: Choudhary
authors.affiliation: Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Gayathri
authors.initials: G
authors.lastname: Petluri
authors.affiliation: Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Vivek
authors.initials: V
authors.lastname: Lal
mesh_terms: D000328:Adult; D000372:Agglutination Tests; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000097:blood / Q000276:immunology; D001921:Brain / Q000000981:diagnostic imaging; D002443:Ceftriaxone / Q000627:therapeutic use; D002524:Cerebellar Ataxia / Q000175:diagnosis* / Q000209:etiology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007919:Leptospira / Q000276:immunology / Q000302:isolation & purification*; D007922:Leptospirosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D008279:Magnetic Resonance Imaging
chemical_list: D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D007075:Immunoglobulin M; D002443:Ceftriaxone
keywords: Ataxia; Febrile illness; Immune mediated; Leptosiprosis