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Das A. Acute Cerebellitis and Obstructive Hydrocephalus: An Unseen Neurological Complication After Surgical Repair for Tetralogy of Fallot. Cureus 2024; 16:e62355. [PMID: 39006608 PMCID: PMC11246560 DOI: 10.7759/cureus.62355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2024] [Indexed: 07/16/2024] Open
Abstract
Acute cerebellitis with obstructive hydrocephalus post-Tetralogy of Fallot surgery is extremely rare but can present aggressively in pediatric cases. Early diagnosis is critical for prompt medical and surgical intervention. We report a fatal case in a 7-year-old boy post-surgery, where neurological symptoms rapidly progressed, leading to drowsiness and intermittent response to commands. Despite initial computed tomography scans showing no abnormality, subsequent scans revealed cerebellitis and hydrocephalus. Treatment with steroids, antibiotics, and cerebrospinal fluid drainage was unsuccessful, and the condition's etiology remained unclear despite negative serological tests and cultures. This highlights the challenge of diagnosing and treating acute cerebellitis, especially when no specific cause is found and when deterioration is swift. The role of opioids in pediatric patients and their potential association with neurosurgical complications is also discussed, prompting further inquiry into postoperative symptoms and opioid-related risks in susceptible individuals.
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Affiliation(s)
- Anupam Das
- Cardiothoracic Vascular Surgery, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
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Monzani NA, Corsello A, Tagliabue C, Pinzani R, Mauri E, Agostoni C, Milani GP, Dilena R. Early acute cerebellar ataxia after meningococcal B vaccine: a case report of a 7-month-old infant and a review of the literature. Ital J Pediatr 2023; 49:61. [PMID: 37277843 DOI: 10.1186/s13052-023-01480-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/26/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Acute cerebellar ataxia (ACA) and acute cerebellitis represent disorders characterized by a para-infectious, post-infectious, or post-vaccination cerebellar inflammation. They are relatively common neurologic disorders among children, and may follow infections, or, more rarely, vaccinations. Few cases are instead described among infants. Although the immunization with meningococcal group B (MenB) vaccine has been associated with some neurological side effects, suspected ACA has been reported only once in the literature. CASE PRESENTATION we describe a 7-month-old female that presented ACA within 24 h from the MenB second dose vaccination. Extensive laboratory studies and magnetic resonance imaging excluded other causes. We then conducted an extended review of other vaccine related cases reported in the literature, focusing on the clinical characteristics of ACA and finding that ataxia and cerebellitis of para- or post-infectious cause are very rarely described in the first year of life. We collected 20 articles published in the last 30 years, including an amount of 1663 patients (1-24 years) with ACA. CONCLUSIONS a very small number of suspected post-vaccinal ataxias has been described in recent years, compared to other causes, and vaccination remains an unquestionable medical need. Further research is needed to clarify the complex pathogenesis of this disorder and its eventual link with vaccinations.
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Affiliation(s)
- Nicola Adriano Monzani
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Milan, Italy
| | - Antonio Corsello
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Claudia Tagliabue
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, SC Pediatria Pneumoinfettivologia, Milan, Italy
| | - Raffaella Pinzani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, SC Pediatria Pneumoinfettivologia, Milan, Italy
| | - Eleonora Mauri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, S.C. Neurofisiopatologia, Milan, Italy
| | - Carlo Agostoni
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Unit, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Gregorio Paolo Milani
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Unit, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Robertino Dilena
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, S.C. Neurofisiopatologia, Milan, Italy.
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Schmidt D. [Ocular symptoms in cerebellitis caused by COVID-19 : Cerebellitis, a less noticed disease with neuro-ophthalmological findings]. DIE OPHTHALMOLOGIE 2023; 120:2-6. [PMID: 36169716 PMCID: PMC9516533 DOI: 10.1007/s00347-022-01725-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 07/11/2022] [Accepted: 08/16/2022] [Indexed: 01/28/2023]
Abstract
The disease pattern of acute cerebellitis has been increasingly noticed in recent years. Two different courses had been observed. A mild form with slight ataxic disorders (as a postinfectious self-limiting disease) and a fulminant course of cerebellitis with cerebellar swelling, which compresses Sylvius' aqueduct, leading to an increased intracranial pressure with an obstructive hydrocephalus, and downward herniation of the cerebellar tonsils in the foramen magnum. In this case the course can be fatal if neurosurgical emergency treatment comes too late. Cerebellitis has been observed as a sequela to a virus infection and by autoimmune-mediated inflammation. Numerous publications were concerned with childhood cerebellitis but less commonly in adults. Neuro-ophthalmological findings were frequently described as nystagmus (horizontal gaze-evoked nystagmus, vertical nystagmus, downbeat nystagmus, periodic alternating nystagmus), papilledema, more rarely paresis of the abducens or facial nerve, photophobia and very rarely an opsoclonous-myoclonous syndrome. Cerebellitis with neuro-ophthalmological findings has repeatedly been described in adults during the coronavirus disease 2019 (COVID-19) pandemic.
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Affiliation(s)
- Dieter Schmidt
- Klinik für Augenheilkunde der Universität, Killianstr. 5, 79106 Freiburg, Deutschland
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Duna CC, Ana FR, Jorgina V, Ignacio DÁ, Alfons M, Érika A. Headache and Vomiting in an 8-Year-Old Girl. Clin Pediatr (Phila) 2022; 61:808-812. [PMID: 35766460 DOI: 10.1177/00099228221106429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Casadesús-Cabral Duna
- Pediatric Hospitalization Unit, Department of Pediatrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Felipe-Rucián Ana
- Neurology Section, Department of Pediatrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Vila Jorgina
- Pediatric Hospitalization Unit, Department of Pediatrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Macaya Alfons
- Neurology Section, Department of Pediatrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Arnó Érika
- Pediatric Hospitalization Unit, Department of Pediatrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Gunaratna GPS, Mohammad SS, Blyth CC, Clark J, Crawford N, Marshall H, Dale RC, Jones CA, Britton PN. Postinfectious Acute Cerebellar Syndromes in Children: A Nationally Ascertained Case Series From Australia 2013-2018. J Child Neurol 2022; 37:8830738221093209. [PMID: 35546546 DOI: 10.1177/08830738221093209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Postinfectious acute cerebellar syndromes show a wide spectrum of acute severity and can occur with acute febrile illness or vaccine receipt. Varicella has historically been the most common cause, associated with up to 25% of cases in large cohorts. This study aimed to describe the spectrum of syndromes in a setting with high varicella vaccine coverage. METHOD Data were collected on children initially identified as "suspected encephalitis" subsequently designated "not-encephalitis" at participating children's hospitals in the Paediatric Active Enhanced Disease Surveillance (PAEDS) network, Australia, as part of the Acute Childhood Encephalitis study. A comprehensive descriptive analysis was undertaken on prospectively identified, national series of children with postinfectious acute cerebellar syndromes from 2013 to 2018. Cases were classified using a previously validated severity score, and the outcome was assessed at 12 months using the Liverpool Outcome Scale score. RESULTS A total of 20 cases (65% were vaccinated for varicella) were included, of which 70% were subcategorized as acute cerebellar ataxia (ACA), 20% acute cerebellitis (AC), and 10% acute fulminant cerebellitis (AFC). An acute febrile illness was noted in 55% and none were related to varicella or were temporally related to varicella vaccination or other childhood vaccines. A subset (total of 7 children) followed up at 12 months all showed reduced Liverpool Outcome Scale scores. DISCUSSION The study provides an overall description of this uncommon spectrum of neurologic syndromes and shows the infrequency of varicella zoster virus as a cause in a vaccinated population.
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Affiliation(s)
- Gayana P S Gunaratna
- Department of Infectious Diseases & Microbiology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Department of Parasitology, Faculty of Medicine, University of Kelaniya, Sri Lanka
| | - Shekeeb S Mohammad
- Department of Neurology and Neurosurgery, Children's Hospital, Westmead, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and health, University of Sydney, Australia
| | - Christopher C Blyth
- Perth Children's Hospital, Nedlands, Perth, Western Australia, Australia
- Telethon Kids Institute and School of Medicine, University of Western Australia, Nedlands, Perth, Western Australia, Australia
- PathWest Laboratory Medicine Western Australia and Queen Elizabeth II Medical Centre, Nedlands, Perth, Western Australia, Australia
| | - Julia Clark
- Children's Health, Brisbane, Queensland, Australia
- School of Clinical Medicine, University of Queensland, Brisbane, Australia
| | - Nigel Crawford
- Murdoch Children's Research Institute and Royal Children's Hospital, Victoria, Australia
- University of Melbourne, Victoria, Australia
| | - Helen Marshall
- Women's and Children's Hospital, South Australia, Australia
- Robinson Research Institute, University of Adelaide, South Australia, Australia
| | - Russell C Dale
- Department of Neurology and Neurosurgery, Children's Hospital, Westmead, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and health, University of Sydney, Australia
| | - Cheryl A Jones
- Department of Neurology and Neurosurgery, Children's Hospital, Westmead, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and health, University of Sydney, Australia
| | - Philip N Britton
- Department of Infectious Diseases & Microbiology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and health, University of Sydney, Australia
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