A 19-year-old woman presented with a one-week history of headache, vomiting and ataxia. A few days earlier, she had an upper airway infection. Brain MRI showed diffuse swelling and hyperintensities of the cerebellar hemispheres (Figure). Laboratory studies did not reveal any etiological factor. She was started on mannitol and dexamethasone, completely improving over the next days.
Brain magnetic resonance imaging at presentation. (A) Axial T2-weighted image shows increased signal intensity in both cerebellar hemispheres and compression of the 4th ventricle; (B) Coronal T2-weighted image showing cerebellar cortex hyperintensities; (C) Sagittal T1-weighted image demonstrating partial compression of 4th ventricle and brainstem; (D) Axial T2-weighted image shows enlargement of the lateral ventricles and subtle intersticial peri-ependimary edema (arrow).
Acute cerebellitis is characterized by diffuse or focal cerebellar swelling11 Bakshi R, Bates VE, Kinkel PR, MechtleR LL, Kinkel WR. Magnetic resonance imaging findings in acute cerebellitis. Clin Imaging. 1998;22(2):79-85. doi:10.1016/S0899-7071(97)00093-4,22 Sawaishi Y, Takada G. Acute cerebellitis. Cerebellum. 2002;1(3):223-8. doi:10.1080/14734220260418457, sometimes compressing or even occluding the fourth ventricle33 Kamate M, Chetal V, Hattiholi V. Fulminant cerebellitis: a fatal clinically isolated syndrome. Pediatr Neurol. 2009;41(3):220-2. doi:10.1016/j.pediatrneurol.2009.03.018. Treatment relies on corticosteroids44 Yis U, Kurul SH, Cakmakçi H, Dirik E. Acute cerebellitis with cerebellar swelling successfully treated with standard dexamethasone treatment. Cerebellum. 2008;7(3):430-2. doi:10.1007/s12311-008-0045-9. As it may be confused with infiltrative tumors33 Kamate M, Chetal V, Hattiholi V. Fulminant cerebellitis: a fatal clinically isolated syndrome. Pediatr Neurol. 2009;41(3):220-2. doi:10.1016/j.pediatrneurol.2009.03.018, knowledge of this condition is important to avoid unnecessary procedures.
References
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1Bakshi R, Bates VE, Kinkel PR, MechtleR LL, Kinkel WR. Magnetic resonance imaging findings in acute cerebellitis. Clin Imaging. 1998;22(2):79-85. doi:10.1016/S0899-7071(97)00093-4
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2Sawaishi Y, Takada G. Acute cerebellitis. Cerebellum. 2002;1(3):223-8. doi:10.1080/14734220260418457
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3Kamate M, Chetal V, Hattiholi V. Fulminant cerebellitis: a fatal clinically isolated syndrome. Pediatr Neurol. 2009;41(3):220-2. doi:10.1016/j.pediatrneurol.2009.03.018
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4Yis U, Kurul SH, Cakmakçi H, Dirik E. Acute cerebellitis with cerebellar swelling successfully treated with standard dexamethasone treatment. Cerebellum. 2008;7(3):430-2. doi:10.1007/s12311-008-0045-9
Publication Dates
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Publication in this collection
06 Oct 2015 -
Date of issue
Nov 2015
History
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Received
09 Apr 2015 -
Reviewed
30 May 2015 -
Accepted
18 June 2015
