Presentation
Acute onset of dysarthria, nystagmus, truncal ataxia, tremor, headache and fever.
Patient Data
There is multifocal cerebellar cortical and vermian signal alteration:
Normal diffusion and ADC mapping
Normal SWI
Avid enhancement of the cerebellar cortex, vermis and regional leptomeninges
There is normal supratentorial imaging.
A lumbar puncture revealed a pleocytosis (lymphocytes and leukocytes) suggesting meningoencephalitis. Unfortunately, no specific organism was found or cultured on CSF or serum.
There is evidence of a past EBV infection, however, negative EBV PCR testing confirmed an absence of EBV reactivation.
Case Discussion
An example of acute pediatric cerebellitis. The CSF analysis suggested meningoencephalitis however the exact infectious organism/s were not identified. The initial work-up for auto-immune etiology is also negative. The child was treated with broad-spectrum intravenous antibiotics and anti-viral therapy and improved significantly after 10 days of treatment.
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