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Título

ACUTE POSTINFECTIOUS CEREBELLAR ATAXIA: CASE REPORT

RESUMO

CASE PRESENTATION: A previously healthy 16-year-old boy presented onset of his clinical condition pain in his right leg and diarrhea, subsequent odynophagia, fever, and headache. Diagnosed with a viral infection, prescribed azithromycin, which he used without symptom improvement. After a three days his symptoms evolved into mental confusion, dysphonia, photophobia, fever, emesis, asthenia. While in hospital, he evolved with nystagmus, ataxia, slow speech and vertigo. Brain MRI was performed, showing hypersignal T2/FLAIR on cerebellar topography suggestive of viral cerebellitis. Lumbar puncture with CSF analysis was performed, without changes. The patient was initially treated with acyclovir, with significant improvement of symptoms and ataxic syndrome. Later on, pulse therapy with methylprednisolone 1g/day for 5 days was performed, also with improvement of symptoms, leading to him being discharged from the hospital. Patient returned for follow-up of postinfectious cerebellitis after three months. Neurological examination evidenced that the patient was oriented, without speech alterations, grade 5 strength in both MS and MI bilaterally, gait with no alterations, with unaltered cerebellar tests and complete improvement of vertiginous symptoms. DISCUSSION:The acute cerebellitis is a rare condition with an inflammatory disorder that can cause a different range of symptoms. The most common symptoms are ataxia, vomiting and headache. The most affected population is the pediatric one. It is important to know that acute postinfectious cerebellar ataxia is a subgroup of acute cerebellitis and they both have symptoms of cerebellar ataxia. By definition an acute cerebellitis is a dysfunction attribute to a recent infectious illness, vaccination or ingestion of medication and with a magnetic resonance imaging (MRI) showing isolated cerebellar inflammation. There are three outcomes for cerebellar ataxia: full recovery, mild neurologic sequelae not affecting play and school activities or mobility, or moderate/severe sequelae requiring special treatment or education. The patient in question showed total improvement in his condition. FINAL COMMENTS: Considering that there is a lack of knowledge about the incidence of this neurological condition, it is necessary to discuss and share data related cases of post-infectious cerebellitis, in order to possible future prospective studies about the incidence and risk factors.

Palavras Chave

ataxia, cerebellitis, cerebellar disease