Acute cerebellitis in paediatric patients: Our experience.
BACKGROUND
Acute cerebellitis is a rare inflammatory disease with a highly variable clinical course that ranges from benign self-limiting symptoms to a fulminant presentation associated with a high risk of death due to compression of the posterior fossa, acute hydrocephalus, and intracranial hypertension.


METHODS
We reviewed clinical, laboratory, and radiological findings from children diagnosed with acute cerebellitis between May 2007 and November 2016. We analysed treatments and clinical and radiological progression.


RESULTS
Nine children met the diagnostic criteria for cerebellitis. Headache, vomiting, and drowsiness were the most frequent initial symptoms; ataxia, dysarthria, and dysmetria were the most common cerebellar signs. Cerebellitis was diagnosed with magnetic resonance imaging, which revealed cerebellar involvement (unilateral or bilateral); computerised tomography images either were normal or showed indirect signs such as triventricular hydrocephalus due to extrinsic compression of the aqueduct of Sylvius. Corticosteroids were the most commonly used treatment (6 patients). One patient required surgery due to triventricular hydrocephalus. Eight patients recovered completely, whereas the ninth displayed neurological sequelae.


CONCLUSIONS
Cerebellitis is a medical and surgical emergency; diagnosis requires a high level of suspicion and an emergency brain magnetic resonance imaging study. It is a clinical-radiological syndrome characterised by acute or subacute encephalopathy with intracranial hypertension and cerebellar syndrome associated with T2-weighted and FLAIR hyperintensities in the cerebellar cortex (unilaterally or bilaterally) and possible triventricular dilatation. Treatment is based on high-dose corticosteroids and may require external ventricular drain placement and decompressive surgery.
Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Miguel Servet, Zaragoza, España. Electronic address: dr_jpablo@hotmail.com.
J P
JP
García-Iñiguez
Neuropediatría, Hospital Infantil Universitario Miguel Servet, Zaragoza, España.
F J
FJ
López-Pisón
Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Miguel Servet, Zaragoza, España.
P
P
Madurga Revilla
Radiología, Hospital Infantil Universitario Miguel Servet, Zaragoza, España.
I
I
Montejo Gañán
Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Miguel Servet, Zaragoza, España.
M
M
Domínguez Cajal
Neuropediatría, Hospital Infantil Universitario Miguel Servet, Zaragoza, España.
L
L
Monge Galindo
Neuropediatría, Hospital Infantil Universitario Miguel Servet, Zaragoza, España.
S B
SB
Sánchez Marco
Neuropediatría, Hospital Infantil Universitario Miguel Servet, Zaragoza, España.
M C
MC
García Jiménez
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001259:Ataxia; D002524:Cerebellar Ataxia; D002526:Cerebellar Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D002531:Cerebellum / Q000000981:diagnostic imaging / Q000473:pathology*; D002552:Cerebral Ventricles / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D004660:Encephalitis; D005260:Female; D006801:Humans; D006849:Hydrocephalus; D007249:Inflammation; D019586:Intracranial Hypertension; D008279:Magnetic Resonance Imaging; D008297:Male; D014057:Tomography, X-Ray Computed
D000305:Adrenal Cortex Hormones
Ataxia; Cefalea; Cerebelitis; Cerebellitis; Headache; Hidrocefalia triventricular; Hipertensión intracraneal; Intracranial hypertension; Triventricular hydrocephalus