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Vivekanandan A, Santyr B, Ranger A. Effects of systemic corticosteroid treatment on pseudotumoral hemicerebellitis: a case report and literature review. Childs Nerv Syst 2021; 37:2105-2113. [PMID: 33219391 DOI: 10.1007/s00381-020-04970-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/10/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Pseudotumoral hemicerebellitis is an acute, unilateral inflammation of the cerebellum that typically affects the pediatric population. The purpose of this paper is to review cases of pseudotumoral hemicerebellitis in the literature and evaluate if treatment with systemic corticosteroids reduces length of time to symptomatic recovery. METHODS We present a case report of a 12-year-old male with pseudotumoral hemicerebellitis and unilateral cerebellar dysfunction. Additionally, we review the thirty-five reported cases of pseudotumoral hemicerebellitis with respect to length of time to symptomatic recovery with or without systemic corticosteroid treatment. RESULTS Thirty cases reported length of time to symptomatic recovery. Including our case, the mean time to recovery for those treated with systemic corticosteroids (n = 20) was 48.05 days (SE = 16.3). The mean time to recovery for those treated without (n = 10) was 86.7 days (SE = 29.3). CONCLUSIONS Treatment with systemic corticosteroids was associated with a faster time to symptomatic recovery compared to without. Regardless of etiology, reducing inflammation and mass effect involved in pseudotumoral hemicerebellitis may be integral to a more rapid return to neurological baseline.
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Affiliation(s)
- Amirti Vivekanandan
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
| | - Brendan Santyr
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Adrianna Ranger
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Paediatric Neurosurgery, Children's Hospital, London Health Sciences Centre, Victoria Campus, London, Ontario, Canada
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Kornreich L, Shkalim-Zemer V, Levinsky Y, Abdallah W, Ganelin-Cohen E, Straussberg R. Acute Cerebellitis in Children: A Many-Faceted Disease. J Child Neurol 2016; 31:991-7. [PMID: 26961264 DOI: 10.1177/0883073816634860] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 12/06/2015] [Indexed: 11/16/2022]
Abstract
Acute cerebellitis is a rare inflammatory condition. It may have a benign, self-limiting course or present as a fulminant disease resulting in severe cerebellar damage or even sudden death. We present the clinical, laboratory, and radiologic data in 9 children diagnosed with acute cerebellitis, who were identified by database search in our pediatric medical center from January 2000 to November 2014. The main presenting symptom was headache, and the main presenting sign was ataxia. Bilateral diffuse hemispheric involvement was the most common imaging finding at presentation. Mycoplasma pneumoniae was the most common infectious pathogen found. Treatment included steroids in all cases, antibiotics in 4, and intravenous immunoglobulins in 6. Six patients had a full recovery, and 3 had residual neurologic complications. Magnetic resonance imaging (MRI) is the modality of choice for diagnosis. The course of acute cerebellitis varies from a commonly benign and self-limiting disease to an occasionally fulminant disease, resulting in severe cerebellar damage or sudden death.
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Affiliation(s)
- Liora Kornreich
- Department of Imaging, Schneider Children's Medical Center of Israel, Petach Tikva, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vered Shkalim-Zemer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Yoel Levinsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Wafa Abdallah
- Department of Neurology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Esther Ganelin-Cohen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Department of Neurology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Rachel Straussberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Department of Neurology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
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Bosemani T, Steinlin M, Toelle SP, Beck J, Boltshauser E, Huisman TAGM, Poretti A. Pseudotumoral hemicerebellitis as a mimicker of Lhermitte-Duclos disease in children: does neuroimaging help to differentiate them? Childs Nerv Syst 2016; 32:865-71. [PMID: 26649682 DOI: 10.1007/s00381-015-2977-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 12/02/2015] [Indexed: 11/28/2022]
Abstract
The clinical presentation and neuroimaging findings of children with pseudotumoral hemicerebellitis (PTHC) and Lhermitte-Duclos disease (LDD) may be very similar. The differentiation between these entities, however, is important because their management and prognosis are different. We report on three children with PTHC. For all three children, in the acute situation, the differentiation between PTHC and LDD was challenging. A review of the literature shows that a detailed evaluation of conventional and neuroimaging data may help to differentiate between these two entities. A striated folial pattern, brainstem involvement, and prominent veins surrounding the thickened cerebellar foliae on susceptibility weighted imaging favor LDD, while post-contrast enhancement and an increased choline peak on (1)H-Magnetic resonance spectroscopy suggest PTHC.
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Affiliation(s)
- Thangamadhan Bosemani
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maja Steinlin
- Department of Pediatric Neurology, University Children's Hospital, Bern, Switzerland
| | - Sandra P Toelle
- Department of Pediatric Neurology, University Children's Hospital, Zurich, Switzerland
| | - Jürgen Beck
- Department of Neurosurgery, University Hospital, Bern, Switzerland
| | - Eugen Boltshauser
- Department of Pediatric Neurology, University Children's Hospital, Zurich, Switzerland
| | - Thierry A G M Huisman
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrea Poretti
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Alberini E, Vellante V, Zennaro F, Calligaris L, Barbi E, Carrozzi M, Devescovi R. Acute pseudotumoral hemicerebellitis in a child: a rare and distinct entity? J Child Neurol 2015; 30:496-9. [PMID: 25143480 DOI: 10.1177/0883073814545114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 07/01/2014] [Indexed: 11/16/2022]
Abstract
A pseudotumoral presentation of acute hemicerebellitis is rare in pediatric age. The authors report a new single case study of a 7-year-old child with pseudotumoral unilateral cerebellitis mimicking an intracranial tumor, which clinically presented itself with signs of intracranial hypertension and mild contralateral hemiparesis, completely recovered after anti-inflammatory therapy. Brain magnetic resonance imaging (MRI) was essential for the differential diagnosis between inflammatory and neoplastic processes. The literature highlighting specific clues about pseudotumoral hemicerebellitis as a distinct clinical and radiological entity is reviewed.
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Affiliation(s)
- Elena Alberini
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| | - Valerio Vellante
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| | - Floriana Zennaro
- Division of Radiology, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| | - Lorenzo Calligaris
- Pediatric Emergency Department, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| | - Egidio Barbi
- Pediatric Emergency Department, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| | - Marco Carrozzi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| | - Raffaella Devescovi
- Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
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Suzuki K, Nakamura T, Numao A, Fujita H, Komagamine T, Nagashima T, Asakawa Y, Watanabe Y, Takekawa H, Hirata K. Acute hemicerebellitis in a young adult: a case report and literature review. J Neurol Sci 2014; 347:364-7. [PMID: 25454647 DOI: 10.1016/j.jns.2014.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 10/07/2014] [Accepted: 10/08/2014] [Indexed: 11/29/2022]
Abstract
Acute hemicerebellitis, marked by headache with or without cerebellar signs, is a rare clinical entity involving a unilateral cerebellar hemisphere. The pathogenesis of acute hemicerebellitis remains unclear, and the disease rarely occurs in adults. Here, we report an 18-year-old woman who presented with a lack of coordination of the right hand and leg lasting longer than one week, following a pulsatile headache. A neurological examination disclosed ocular dysmetria, right-sided limb ataxia and slight truncal ataxia. Cerebrospinal fluid analysis showed mononuclear pleocytosis. The serology and autoimmune studies were unremarkable. Brain magnetic resonance imaging (MRI) revealed a focal signal change in the right cerebellar hemisphere and vermis. Acute hemicerebellitis was diagnosed, and the patient was treated with intravenous methylprednisolone sodium succinate and acyclovir. Subsequently, the headache resolved, and the cerebellar signs were markedly improved. Twenty days after admission, she became asymptomatic and brain MRI showed resolution of cerebellar hyperintensity on the right side. In conclusion, we identified only 6 additional patients with adult-onset acute hemicerebellitis from previous reports, highlighting the importance of recognizing this rare clinical entity. Its clinical outcome is usually favorable, but in the acute phase, attention should be directed toward clinical symptoms that are suggestive of increased intracranial pressure.
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Affiliation(s)
- Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan.
| | - Toshiki Nakamura
- Department of Neurology, Rehabilitation Amakusa Hospital, Saitama, Japan
| | - Ayaka Numao
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Hiroaki Fujita
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | | | | | - Yohei Asakawa
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Yuji Watanabe
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | | | - Koichi Hirata
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
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