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Acute cerebellitis

Case contributed by Ammar Haouimi
Diagnosis almost certain

Presentation

Four days history of fever, nausea, vomiting and truncal ataxia

Patient Data

Age: 7 years
Gender: Male
mri

The MRI sequences demonstrate:

  • swelling of both cerebellar hemispheres with ill-defined areas of low signal on T1WI, high signal on T2WI/FLAIR involving both grey and white matter (cerebellar edema) with regions of restricted diffusion as well as increased diffusivity on ADC map. The multivoxel MR spectroscopy shows low NAA/Cr and NAA/Cho ratios
  • mild leptomeningeal enhancement is noted along the cerebellar hemispheres mainly on the right
  • a mass effect on the 4th ventricle with tonsillar herniation. Mild upward cerebellar displacement with a mass effect on the brainstem and quadrigeminal cistern
  • dilated third and lateral ventricles in keeping with obstructive hydrocephalus

Case Discussion

MRI features are most consistent with an acute cerebellitis.

 

Additional contributors: A. Ramdani, MD / ZE. Boudiaf, MD

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