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García-Iñiguez J, López-Pisón F, Madurga Revilla P, Montejo Gañán I, Domínguez Cajal M, Monge Galindo L, Sánchez Marco S, García Jiménez M. Acute cerebellitis in paediatric patients: Our experience. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2018.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Emelifeonwu JA, Shetty J, Kaliaperumal C, Gallo P, Sokol D, Soleiman H, Kandasamy J. Acute Cerebellitis in Children: A Variable Clinical Entity. J Child Neurol 2018; 33:675-684. [PMID: 29888646 DOI: 10.1177/0883073818777673] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute cerebellar ataxia is the most common cause of acute ataxia in children and it usually runs a self-limiting and ultimately benign clinical course. A small proportion of children have evidence of inflammatory swelling in the cerebellum. Many of these children suffer more severe and potentially life-threatening forms of cerebellar ataxia and may need more intensive treatments including urgent neurosurgical treatments. This more severe form of acute cerebellar ataxia is often termed acute cerebellitis. Many children with acute cerebellitis have long-term neurological sequela and evidence of structural cerebellar changes on follow-up imaging. Several patterns of cerebellar inflammation have been described. The authors describe the variabilities in the clinical and radiological patterns of disease in the cases that have been described in the literature.
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Affiliation(s)
- John Amaechi Emelifeonwu
- 1 Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.,2 Department of Clinical Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK
| | - Jay Shetty
- 2 Department of Clinical Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK
| | | | - Pasquale Gallo
- 2 Department of Clinical Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK
| | - Drahoslav Sokol
- 2 Department of Clinical Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK
| | - Hamza Soleiman
- 1 Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | - Jegajothy Kandasamy
- 2 Department of Clinical Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK
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García-Iñiguez JP, López-Pisón FJ, Madurga Revilla P, Montejo Gañán I, Domínguez Cajal M, Monge Galindo L, Sánchez Marco SB, García Jiménez MC. Acute cerebellitis in paediatric patients: Our experience. Neurologia 2017; 34:291-299. [PMID: 28318729 DOI: 10.1016/j.nrl.2017.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 12/22/2016] [Accepted: 01/01/2017] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Acute cerebellitis is a rare inflammatory disease with a highly variable clinical course that ranges from benign self-limiting symptoms to a fulminant presentation associated with a high risk of death due to compression of the posterior fossa, acute hydrocephalus, and intracranial hypertension. METHODS We reviewed clinical, laboratory, and radiological findings from children diagnosed with acute cerebellitis between May 2007 and November 2016. We analysed treatments and clinical and radiological progression. RESULTS Nine children met the diagnostic criteria for cerebellitis. Headache, vomiting, and drowsiness were the most frequent initial symptoms; ataxia, dysarthria, and dysmetria were the most common cerebellar signs. Cerebellitis was diagnosed with magnetic resonance imaging, which revealed cerebellar involvement (unilateral or bilateral); computerised tomography images either were normal or showed indirect signs such as triventricular hydrocephalus due to extrinsic compression of the aqueduct of Sylvius. Corticosteroids were the most commonly used treatment (6 patients). One patient required surgery due to triventricular hydrocephalus. Eight patients recovered completely, whereas the ninth displayed neurological sequelae. CONCLUSIONS Cerebellitis is a medical and surgical emergency; diagnosis requires a high level of suspicion and an emergency brain magnetic resonance imaging study. It is a clinical-radiological syndrome characterised by acute or subacute encephalopathy with intracranial hypertension and cerebellar syndrome associated with T2-weighted and FLAIR hyperintensities in the cerebellar cortex (unilaterally or bilaterally) and possible triventricular dilatation. Treatment is based on high-dose corticosteroids and may require external ventricular drain placement and decompressive surgery.
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Affiliation(s)
- J P García-Iñiguez
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Miguel Servet, Zaragoza, España.
| | - F J López-Pisón
- Neuropediatría, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
| | - P Madurga Revilla
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
| | - I Montejo Gañán
- Radiología, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
| | - M Domínguez Cajal
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
| | - L Monge Galindo
- Neuropediatría, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
| | - S B Sánchez Marco
- Neuropediatría, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
| | - M C García Jiménez
- Neuropediatría, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
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Carceller Lechón F, Duat Rodríguez A, Sirvent Cerdá SI, Khabra K, de Prada I, García-Peñas JJ, Madero López L. Hemicerebellitis: Report of three paediatric cases and review of the literature. Eur J Paediatr Neurol 2014; 18:273-81. [PMID: 24423631 DOI: 10.1016/j.ejpn.2013.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 12/09/2013] [Accepted: 12/10/2013] [Indexed: 10/25/2022]
Abstract
Acute inflammation of a single cerebellar hemisphere (hemicerebellitis) is a rare disorder of unknown origin. The clinical presentation is mainly characterized by headache, ataxia, dysmetria, and vomiting. In addition, some children may develop severe intracranial hypertension. The neuroimaging of hemicerebellitis raises a challenging differential diagnosis, particularly with posterior fossa tumours. Although there is no standard treatment for hemicerebellitis, its outcome is usually favourable. However, ipsilateral hemicerebellar atrophy develops in up to half of cases, and a minority of children may show persisting fine motor and/or neurocognitive sequelae. In this article, we contribute with three new reports and review a total of 35 cases of hemicerebellitis.
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Affiliation(s)
| | | | | | - Komel Khabra
- Department of Statistics, Royal Marsden Hospital, Sutton, Surrey, United Kingdom
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Expanding the spectrum of neurological disease associated with Epstein-Barr virus activity. Eur J Clin Microbiol Infect Dis 2011; 30:1561-9. [PMID: 21573818 DOI: 10.1007/s10096-011-1261-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 03/30/2011] [Indexed: 01/26/2023]
Abstract
The purpose of this study was to delineate the spectrum of neurological diseases attributed to Epstein-Barr virus (EBV) activity. The approach was a retrospective study on patients with EBV activity proven by a positive EBV antibody-specific index (AI) and/or cerebrospinal fluid (CSF) PCR. One hundred six children and adults (AI positive = 77, AI + PCR positive = 3, PCR positive = 26) were identified, most with reactivated infections. Twenty-eight showed typical EBV-related diseases (encephalitis, neuritis, meningitis), 19 further infections (HSV encephalitis, neuroborreliosis, HIV infection, bacterial meningitis), nine immune-mediated disorders (multiple sclerosis, optic neuritis), and 50 further diseases not typical for EBV. The highest AI values occurred in patients with encephalitis. No relationship between disease category or AI values and viral loads was found. Additional reanalysis of 1,500 consecutive CSF EBV PCR studies revealed the highest positive rates among patients with further infections (n = 18/227, 7.9%) but lower rates among patients with typical EBV-related disorders (5/395; 1.3%), immune-mediated disorders (n = 2/174; 1.1%) and other conditions (n = 4/704; 0.6%). Intrathecal EBV activity is not restricted to typical EBV-related disorders, unexpectedly frequent in further CNS infections and also present in non-inflammatory conditions. Prospective studies should assess the pathogenic role of EBV in these different diseases.
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Abul-Kasim K, Palm L, Maly P, Sundgren PC. The neuroanatomic localization of Epstein-Barr virus encephalitis may be a predictive factor for its clinical outcome: a case report and review of 100 cases in 28 reports. J Child Neurol 2009; 24:720-6. [PMID: 19151367 DOI: 10.1177/0883073808327842] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Encephalitis is one of the manifestations of infection with Epstein-Barr virus with clinical outcome varying from complete recovery to death. A 16-year-old boy with Epstein-Barr virus encephalitis with global cortical and subcortical gray matter involvement and a full clinical recovery is reported. The case inspired a literature review which yielded 100 cases of Epstein-Barr virus encephalitis subjected to radiological investigation and published in 28 reports. Cerebellum and basal ganglia were reported to be equally involved by Epstein-Barr virus infection, next to cerebral hemisphere. Patients with isolated hemispheric gray or white matter involvement were reported to achieve good recovery while almost half of the patients with thalamic involvement developed sequelae. The highest mortality rate was among patients with isolated brain stem involvement. In conclusion, neuroanatomic distribution of the radiological abnormalities in Epstein-Barr virus encephalitis may be useful as a prognostic marker.
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Affiliation(s)
- Kasim Abul-Kasim
- Department of Radiology, Section of Neuroradiology, Malmö University Hospital, University of Lund, Sweden.
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Yiş U, Kurul SH, Cakmakçi H, Dirik E. Acute cerebellitis with cerebellar swelling successfully treated with standard dexamethasone treatment. THE CEREBELLUM 2009; 7:430-2. [PMID: 18594939 DOI: 10.1007/s12311-008-0045-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Although cerebellitis is common in childhood but cerebellitis with cerebellar swelling is rarely reported. Pulsed high dose methylprednisolone treatment is the choice of treatment for cases who have non-progressive symptoms. An 8-year-old girl presented acutely with vertigo, headache, and vomiting. Brain magnetic resonance imaging showed marked bilateral cerebellar swelling with increased signal on T2-weighted imaging. Following treatment with standard dexamethasone dose, the clinical and radiological signs resolved in 1 week. We conclude that standard dexamethasone treatment should be used in mild cases of acute cerebellitis in order to avoid adverse reactions of pulsed high dose methylprednisolone treatment.
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Affiliation(s)
- Uluç Yiş
- Department of Pediatrics Division of Child Neurology, Dokuz Eylül University School of Medicine, 35340 Izmir, Turkey.
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Sanefuji M, Ohga S, Kira R, Nomura A, Torisu H, Takada H, Kusuhara K, Hara T. Epstein-Barr virus-associated meningoencephalomyelitis: intrathecal reactivation of the virus in an immunocompetent child. J Child Neurol 2008; 23:1072-7. [PMID: 18827273 DOI: 10.1177/0883073808315414] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neurologic complications, including meningoencephalitis, transverse myelitis, and peripheral neuropathy, have been reported in patients with acute infectious mononucleosis. Chronic active Epstein-Barr virus and human immunodeficiency virus infections occasionally induce central nervous system lymphoma. On the other hand, central nervous system disease alone associated with Epstein-Barr virus rarely occurs in previously healthy individuals. A 15-year-old girl who developed acute disseminated encephalomyelitis-like disease presenting fever, anuresis, diplopia, and muscle weakness is described here. Clinical and neuroimaging studies led to the diagnosis of encephalomyelitis. Despite the absence of infectious mononucleosis-like symptoms, anti-Epstein-Barr virus antibody titers in serum and cerebrospinal fluid showed the virus reactivation. The copy number of Epstein-Barr virus DNA increased in cerebrospinal fluid but not in peripheral blood. Ganciclovir and repeated methyl-prednisolone pulse therapy resulted in complete resolution. Central nervous system disease on the limited intrathecal reactivation of Epstein-Barr virus in immunocompetent children should be differentiated from acute disseminated encephalomyelitis.
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Affiliation(s)
- Masafumi Sanefuji
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Tabarki B, Thabet F. Cérébellite aiguë sévère compliquée d'une compression du tronc cérébral et d'hydrocéphalie d'évolution favorable sous corticothérapie. Arch Pediatr 2007; 14:1007-9. [PMID: 17498931 DOI: 10.1016/j.arcped.2007.03.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2006] [Revised: 02/27/2007] [Accepted: 03/27/2007] [Indexed: 10/23/2022]
Abstract
Severe acute inflammatory cerebellitis is a rare but life threatening disease. We report the case of a 8-year-old boy presenting with cerebellitis and acute cerebellar swelling complicated by brain stem compression and hydrocephalus. Outcome was good on steroid therapy.
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Affiliation(s)
- B Tabarki
- Service de pédiatrie, hôpital militaire Al-Hada, BP 1347, Taif, Arabie Saoudite.
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de Ribaupierre S, Meagher-Villemure K, Villemure JG, Cotting J, Jeannet PY, Porchet F, Roulet E, Bloch J. The role of posterior fossa decompression in acute cerebellitis. Childs Nerv Syst 2005; 21:970-4. [PMID: 15928964 DOI: 10.1007/s00381-005-1176-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2004] [Indexed: 11/26/2022]
Abstract
BACKGROUND We present two cases of children who were diagnosed with cerebellitis with acute cerebellar swelling. This rare pathology is potentially fatal, and no clear treatment guidelines are described in the literature. DISCUSSION Considering our experience, we discuss the different therapeutic strategies and propose aggressive surgical measures consisting of external ventricular drainage and posterior fossa decompression in case of failure of early response to medical treatment to limit secondary cerebellar and brainstem lesions.
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Astigarraga I, Prats JM, Navajas A, Fernández-Teijeiro A, Urberuaga A. Near fatal cerebellar swelling in familial hemophagocytic lymphohistiocytosis. Pediatr Neurol 2004; 30:361-4. [PMID: 15165642 DOI: 10.1016/j.pediatrneurol.2003.11.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2003] [Accepted: 11/25/2003] [Indexed: 10/26/2022]
Abstract
We describe a 3 year-old male who presented with fever and cerebellar dysfunction after varicella. He developed transient hepatosplenomegaly, cytopenias, and progressive central nervous system involvement (coma, status epilepticus, and hydrocephalus). Despite normal initial cranial computed tomographic scan, diffuse swelling of the cerebellum with downward tonsillar herniation ensued. Diagnosis of hemophagocytic lymphohistiocytosis was difficult and delayed because of the relapsing course, and complete diagnostic criteria were not fulfilled at initial presentation. Central nervous system disease preceded the typical clinical picture of this disease; it dominated the clinical course and caused life-threatening complications and sequelae. The patient improved after treatment, according to the hemophagocytic lymphohistiocytosis protocol (HLH-94) of the Histiocyte Society, with dexamethasone, etoposide, and cyclosporine and unrelated cord blood stem cell transplantation. A mutation in the perforin gene confirmed the diagnosis of familial hemophagocytic lymphohistiocytosis.
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Soussan V, Husson B, Tardieu M. [Description and prognostic value of cerebellar MRI lesions in children with severe acute ataxia]. Arch Pediatr 2003; 10:604-7. [PMID: 12907067 DOI: 10.1016/s0929-693x(03)00273-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this work was to evaluate NMR cerebellar abnormalities in children with severe acute ataxia. Among 8 consecutively observed children, NMR performed in 6 during the acute phase was pathological in 4, demonstrating hyperintense signal in the T2-weighed sequences of dentate nuclei (2 cases, associated in 1 with hyperintense signal in the medium cerebellar peduncle) or of the cerebellar cortex associated with cerebellar swelling (2 cases). NMR performed in 7 cases after at least 1 month of evolution showed cerebellar atrophy in 4 cases. After 1 to 6 years of clinical follow-up, 4/8 children had clinical sequellae, including 3 of the 4 children with initially abnormal NMR. Conversely, the 2 patients with initially normal NMR had a good clinical recovery. NMR during the acute phase gives informations on prognosis in patients with severe acute ataxia.
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Affiliation(s)
- V Soussan
- Service de neurologie, département de pédiatrie, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France
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Abstract
Acute childhood ataxia is a common cause of presentation to the pediatric emergency room or child neurologist. The primary concern on initial assessment is to exclude serious causes of this clinical syndrome, including central nervous system infections and mass lesions, while recognizing the essentially benign nature of acute ataxia in most children. Childhood ataxia can be diagnostically approached by consideration of the temporal course and presence or absence of associated neurologic abnormalities. In all forms of childhood ataxia, outcome is largely determined by etiology. In this review, the various causes and syndromes of acute ataxia in childhood are described, with discussion of diagnostic considerations and an approach to investigation, treatment, and prognosis.
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Affiliation(s)
- Monique M Ryan
- Department of Neurology, Children's Hospital Boston, Boston, MA 02115, USA.
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Burri SM, Krauss JK, Schroth G, Weis J, Steinlin M. Near-fatal cerebellar swelling caused by acute multifocal cerebellar necrosis. Eur J Paediatr Neurol 2003; 7:139-42. [PMID: 12788040 DOI: 10.1016/s1090-3798(03)00043-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report a case of acute near-fatal cerebellar swelling, which was accompanied by multifocal cerebellar necrosis. Acute, near-fatal cerebellar swelling is a rare problem thought to be of parainfectious aetiology. Initiation by multifocal cerebellar necrosis has not been reported so far with this disorder.
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Affiliation(s)
- Sandra M Burri
- Department of Paediatrics, University Children's Hospital, Inselspital, Bern, Switzerland
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Häusler M, Ramaekers VT, Doenges M, Schweizer K, Ritter K, Schaade L. Neurological complications of acute and persistent Epstein-Barr virus infection in paediatric patients. J Med Virol 2002; 68:253-63. [PMID: 12210416 DOI: 10.1002/jmv.10201] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Neurological complications of Epstein-Barr virus (EBV) have been reported almost exclusively in the course of acute primary infections. The role of EBV in paediatric neurological disease was investigated prospectively over a 2-year period, searching for acute primary, chronic, and reactivated EBV infections. Active EBV infections were diagnosed in 10/48 patients, including two with acute primary EBV infections (cranial neuritis and cerebellitis), one with chronic active infection (T/NK cell lymphoma with cranial neuritis), and seven with reactivated infections. Among these seven patients, three showed "Alice in Wonderland" syndrome, one facial nerve palsy, one progressive macrocephaly, and two prolonged encephalitic illness. The prognosis was good except for the patient with lethal T/NK cell lymphoma and the two girls with encephalitic illness. Despite steroid treatment, these girls suffered prolonged cognitive impairment and epileptic seizures. Both developed left-sided hippocampal atrophy, and one of them hippocampal sclerosis. Like primary infections, reactivated EBV infections cause neurological complications in a considerable number of paediatric patients, lead to serious long-term complications, and may contribute to the pathogenesis of hippocampal lesions.
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Affiliation(s)
- Martin Häusler
- Department of Paediatrics, Division of Paediatric Neurology, University Hospital, RWTH Aachen, Germany.
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Abstract
Many recent reports of acute cerebellitis with a critical or potentially critical course have changed the conception of the disease from an acute cerebellar ataxia with a benign course to a notable disease entity with a heterogeneous pathogenesis. The most characteristic finding by magnetic resonance imaging is diffuse cortical swelling of the cerebellum, often complicated by hydrocephalus or tonsillar herniation. A timely assessment and appropriate choice of treatment, including surgical intervention when indicated, are key to improving the outcome of affected patients.
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Affiliation(s)
- Yukio Sawaishi
- Department of Pediatrics, Akita University School of Medicine, Akita City, Japan.
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Abstract
BACKGROUND This review examines the causes of ataxias in children. It is a relatively common manifestation of neurological diseases in children. The etiology of ataxia covers a broad range, from infections to rare hereditary metabolic diseases. A systematic approach is required to make the correct diagnosis. REVIEW SUMMARY The more common causes of ataxias in children are discussed in detail. The importance of recognizing potentially reversible conditions such as vitamin E deficiency and Refsum's disease is stressed. Recent advances in molecular genetics of some of the chronic ataxias are discussed. The importance of categorizing diseases based on the duration of symptoms and associated signs is discussed. Treatment options are mentioned. CONCLUSION Ataxia is a common mode of presentation of cerebellar, posterior column, and vestibular disease in children. Awareness of the spectrum of disease entities that cause ataxia in childhood may lead to better diagnosis.
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Affiliation(s)
- J A Gosalakkal
- Department of Pediatric Neurolgy, New York University Medical Center, New New York, NY, USA.
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Affiliation(s)
- J A Gosalakkal
- Department of Pediatric Neurology, NYU Medical Center, NY, USA
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Angelini L, Bugiani M, Zibordi F, Cinque P, Bizzi A. Brainstem encephalitis resulting from Epstein-Barr virus mimicking an infiltrating tumor in a child. Pediatr Neurol 2000; 22:130-2. [PMID: 10738918 DOI: 10.1016/s0887-8994(99)00124-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A case of a child with subacute neurologic features and imaging findings consistent with a brainstem encephalitis that was discovered to be related to a primary central nervous system infection caused by Epstein-Barr virus is presented. A brainstem tumor was initially suspected, but a correct diagnosis was formulated on the basis of the favorable clinical course and the detection of positive Epstein-Barr virus serology. In contrast to a prompt recovery of neurologic signs the neuroimaging alterations persisted for a longer time. The present report emphasizes the possible role of Epstein-Barr virus in the pathogenesis of infectious neurologic disorders in childhood, underlining the unusual presentation of a brainstem encephalitis, and considers the discrepancy between the course of neurologic features and the evolution of imaging alterations.
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Affiliation(s)
- L Angelini
- Department of Neuropediatrics, Istituto Nazionale Neurologico, Milan, Italy
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Schellinger PD, Sommer C, Leithäuser F, Schwab S, Storch-Hagenlocher B, Hacke W, Kiessling M. Epstein-Barr virus meningoencephalitis with a lymphoma-like response in an immunocompetent host. Ann Neurol 1999; 45:659-62. [PMID: 10319890 DOI: 10.1002/1531-8249(199905)45:5<659::aid-ana16>3.0.co;2-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We report the clinical and neuropathological findings in an immunocompetent 19-year-old patient with a fatal acute Epstein-Barr virus (EBV) meningoencephalitis and a lymphoma-like B-lymphocyte response. Our results suggest that an immunotoxic rather than direct viral neuronal invasion mediates brain damage in EBV encephalitis and rule out primary central nervous system lymphoma (PCNSL) in our patient. We discuss immunosuppression as a therapeutic option, because present strategies mainly consist of symptomatic therapy due to unclear pathogenesis and nonavailability of effective antiviral agents.
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Göhlich-Ratmann G, Wallot M, Baethmann M, Schaper J, Roggendorf M, Roll C, Aksu F, Voit T. Acute cerebellitis with near-fatal cerebellar swelling and benign outcome under conservative treatment with high dose steroids. Eur J Paediatr Neurol 1998; 2:157-62. [PMID: 10726838 DOI: 10.1016/s1090-3798(98)80032-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Acute cerebellar swelling is an emergency because of brainstem compression as well as upward or downward cerebellar herniation. Few childhood cases are on record, with fatal outcome in three out of six. We report a girl with probable Epstein-Barr virus-associated cerebellar swelling who recovered completely with steroid treatment after a stormy course. Review of the literature showed that all three patients, including our own, who recovered fully, received high-dose steroids in contrast to none of the four patients who died or survived with sequelae. Neuroimaging and evoked potential studies are useful for early diagnosis and disease monitoring. We conclude that for the time being high-dose steroid treatment is advocated in patients with acute infectious or parainfectious cerebellar swelling.
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Hukin J, Cochrane DD, Crichton JU. Acute swelling of the cerebellum on childhood. J Child Neurol 1997; 12:273-5. [PMID: 9203070 DOI: 10.1177/088307389701200411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- J Hukin
- Department of Paediatrics, University of British Columbia, British Columbia's Children's Hospital, Vancouver, Canada
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