Cerebellitis

Neurology

Clinicals - History

Fact Explanation
Ataxic gait Cerebellar ataxia is typically described as broad-based gait where patient tends to fall on to side same as the most effected side of cerebellum Ataxic gait
Cerebellar ataxia is typically described as broad-based gait where patient tends to fall on to side same as the most effected side of cerebellum
Dysarthria Due to difficult in articulation of the words patient tend to have a scanning speech. Dysarthria
Due to difficult in articulation of the words patient tend to have a scanning speech.
Dysmetry Patient have poor perception of distance, thus tends to over or undershoot while trying to touch a determined point Dysmetry
Patient have poor perception of distance, thus tends to over or undershoot while trying to touch a determined point
Intentional tremor Some patients have been reported to have tremor outlasting the other symptoms of cerebellitis Intentional tremor
Some patients have been reported to have tremor outlasting the other symptoms of cerebellitis
Skin lesions compatible with varicella infection They occur in different stages; some still developing while other maybe in resolution phase.
Symptoms of cerebellitis may even surface without the viral rash, such cases has been reported in both healthy and immunocompetent patients
Skin lesions compatible with varicella infection
They occur in different stages; some still developing while other maybe in resolution phase.
Symptoms of cerebellitis may even surface without the viral rash, such cases has been reported in both healthy and immunocompetent patients
Fever Associated with underlying viral infection Fever
Associated with underlying viral infection
Signs of respiratory or gasterointestinal infection These self limiting signs of viral infection may precede the cerebellar signs. This phenomenon is mainly seen in children and young adults Signs of respiratory or gasterointestinal infection
These self limiting signs of viral infection may precede the cerebellar signs. This phenomenon is mainly seen in children and young adults
Signs of lung tumor, breast tumor or Hodgkin's lymphoma Small cell lung cancer, breast cancer and Hodgkin's lymphoma are associated with paraneoplastic syndrome that results in cerebellar signs Signs of lung tumor, breast tumor or Hodgkin's lymphoma
Small cell lung cancer, breast cancer and Hodgkin's lymphoma are associated with paraneoplastic syndrome that results in cerebellar signs

Clinicals - Examination

Fact Explanation
Nystagmus Elicited by asking the patient to look to one side; downbeat nystagmus is particularly seen in cerebellar lesion where the fast phase beat is in a downward direction. It increases when patient looks to sideward, downward and on lying prone.
Paraneoplastic cerebellar disorders are associated with opsoclonus where there will be a rapid, irregular movements in all directions.
Nystagmus
Elicited by asking the patient to look to one side; downbeat nystagmus is particularly seen in cerebellar lesion where the fast phase beat is in a downward direction. It increases when patient looks to sideward, downward and on lying prone.
Paraneoplastic cerebellar disorders are associated with opsoclonus where there will be a rapid, irregular movements in all directions.
Scanning speech Occurs due to difficulty in articulation. Scanning speech
Occurs due to difficulty in articulation.
Dysmetry and intentional tremor Elicited by finger-nose test in the upper limb and heel-shin test in lower limb. Ask the patient to touch his/ her nose tip and touch the examiner's finger or ask patient to place his heel on the other knee and draw it along the shin upto ankle. Patient with cerebellar lesions will over or undershoot the target and will have coarse tremors while approaching it. Dysmetry and intentional tremor
Elicited by finger-nose test in the upper limb and heel-shin test in lower limb. Ask the patient to touch his/ her nose tip and touch the examiner's finger or ask patient to place his heel on the other knee and draw it along the shin upto ankle. Patient with cerebellar lesions will over or undershoot the target and will have coarse tremors while approaching it.
Dysdiadokokinesia Elicited by asking the patient to place one hand over the other and flip the hand on top in quick alternating movements; patients with cerebellar lesion can't maintain a normal rhythm. Dysdiadokokinesia
Elicited by asking the patient to place one hand over the other and flip the hand on top in quick alternating movements; patients with cerebellar lesion can't maintain a normal rhythm.
Ataxic gait Patients will have broad based ataxic gait Ataxic gait
Patients will have broad based ataxic gait
Rebound phenomenon Positive Rebound phenomenon
Positive

Investigations - Diagnosis

Fact Explanation
Full blood count and ESR Elevated white cell count with high ESR (Erythrocyte Sedimentation Rate) can be found if due to infection. Full blood count and ESR
Elevated white cell count with high ESR (Erythrocyte Sedimentation Rate) can be found if due to infection.
Blood for dengue antibodies Dengue nonstructural protein antigen 1 can be detected during early infection and IgM/ IgG antibody in late presentation. Blood for dengue antibodies
Dengue nonstructural protein antigen 1 can be detected during early infection and IgM/ IgG antibody in late presentation.
Onconeural antibodies These are markers of paraneoplastic syndrome and performed when suspected. Onconeural antibodies
These are markers of paraneoplastic syndrome and performed when suspected.
Autoantibodies Several autoantibodies have been described in primary autoimmune cerebellitis. Ex: Glutamic acid decarboxylase, metabotropic glutamate receptor type 1 (mGluR1), contactin-associated protein 2, Homer-3 antibodies Autoantibodies
Several autoantibodies have been described in primary autoimmune cerebellitis. Ex: Glutamic acid decarboxylase, metabotropic glutamate receptor type 1 (mGluR1), contactin-associated protein 2, Homer-3 antibodies
Lumbar puncture and CSF analysis CSF full report mild lymphocytic pleocytosis is detected in viral infection such as Varicella Zoster Virus, HSV, EBV, CMV, HHV 6-8 14-3-3 protein maybe detected in cerebellitis associated with paraneoplastic syndrome but is not specific to this.
PCR for viruses such as Varicella Zoster virus and if delayed antibodies against them can be detected.
Lumbar puncture and CSF analysis
CSF full report mild lymphocytic pleocytosis is detected in viral infection such as Varicella Zoster Virus, HSV, EBV, CMV, HHV 6-8 14-3-3 protein maybe detected in cerebellitis associated with paraneoplastic syndrome but is not specific to this.
PCR for viruses such as Varicella Zoster virus and if delayed antibodies against them can be detected.
Magnetic resonance imaging (MRI) Hyperintense areas in bilateral cerebellar gray matter in T2-weighted sequences can be visualised but this is not patognomonic and has no prognostic value. If clinically obvious MRI is not recommended and where performed MRI is superior to CT. Magnetic resonance imaging (MRI)
Hyperintense areas in bilateral cerebellar gray matter in T2-weighted sequences can be visualised but this is not patognomonic and has no prognostic value. If clinically obvious MRI is not recommended and where performed MRI is superior to CT.

Investigations - Management

Fact Explanation
No long term complications are expected in acute viral cerebellitis. In multiple long term follow up of patients who have had acute viral cerebellitis there has been no cases of developmental retardation, epilepsy, deafness or disorders directly caused by cerebellitis. No long term complications are expected in acute viral cerebellitis.
In multiple long term follow up of patients who have had acute viral cerebellitis there has been no cases of developmental retardation, epilepsy, deafness or disorders directly caused by cerebellitis.
Cerebellar symptoms may outlast the febrile illness. In a reported case of dengue cerebellar symptoms outlasted fever by weeks. Cerebellar symptoms may outlast the febrile illness.
In a reported case of dengue cerebellar symptoms outlasted fever by weeks.

Management - Specific

Fact Explanation
Antiviral therapy 30 mg/kg/day acyclovir IV for five days is recommended for acute cerebellitis caused by Varicella Zoster Viral infection. But the use of antiviral therapy controversial due to possible autoimmune pathogenesis Antiviral therapy
30 mg/kg/day acyclovir IV for five days is recommended for acute cerebellitis caused by Varicella Zoster Viral infection. But the use of antiviral therapy controversial due to possible autoimmune pathogenesis
Steroids 0.15-0.5 mg/Kg/day dexamethasone IV is recommended in some patients but the use of this is controversial Steroids
0.15-0.5 mg/Kg/day dexamethasone IV is recommended in some patients but the use of this is controversial
Treatment of tumor In cerebellitis caused by paraneoplastic syndrome treatment of the tumor is associated with recovery from symptoms. Treatment with steroids, plasma exchange, IV immunoglobulin or cyclophosphamide does not modify the outcome in patients in whom the tumor has been successfully treated. Treatment of tumor
In cerebellitis caused by paraneoplastic syndrome treatment of the tumor is associated with recovery from symptoms. Treatment with steroids, plasma exchange, IV immunoglobulin or cyclophosphamide does not modify the outcome in patients in whom the tumor has been successfully treated.
Stop the insulting drug If drug induced cerebellitis is suspected, stopping the drug results in improvement of the symptoms. In cases due to isoniazid, pyridoxine can be used. Stop the insulting drug
If drug induced cerebellitis is suspected, stopping the drug results in improvement of the symptoms. In cases due to isoniazid, pyridoxine can be used.

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  1. AMJAD Nida, HAQUE Anwarul, AHMED Khalid. Acute Cerebellitis with Hydrocephalus [online] Journal of the College of Physicians and Surgeons Pakistan 2014, Vol. 24 (Special Supplement 2): S127-S128 [Viewed on 07 November 2014] Available from: http://www.jcpsp.pk/archive/2014/SS_May2014/23.pdf
  2. BOZZOLA ELENA, BOZZOLA MAURO, TOZZI ALBERTO, CALCATERRA VALERIA, LONGO DANIELA, KRZYSTOFIAK ANDRZEJ, VILLANI ALBERTO. Acute cerebellitis in varicella: a ten year case series and systematic review of the literature. [online] Italian Journal of Pediatrics 2014, 40:57 [viewed 29 September 2014] Available from: doi:10.1186/1824-7288-40-57
  3. BOZZOLA ELENA, BOZZOLA MAURO, TOZZI ALBERTO, CALCATERRA VALERIA, LONGO DANIELA, KRZYSTOFIAK ANDRZEJ, VILLANI ALBERTO. Acute cerebellitis in varicella: a ten year case series and systematic review of the literature. [online] Italian Journal of Pediatrics 2014, 40:57 [viewed 29 September 2014] Available from: doi:10.1186/1824-7288-40-57 ********Please be kind enough to note that the previous citatation was one generated by the citation tool with the doi of the article; I have manually corrected it now. Thought letting you know would improve the accuracy of the citation tool.***
  4. CIARDI MARIA, GIACCHETTI GIOVANNA, FEDELE CESARE GIOVANNI, TENORIO ANTONIO, BRANDI ANTONELLA, LIBERTONE RAFFAELLA, AJASSA CAMILLA, BORGESE LEONARDO, DELIA SALVATORE. Acute Cerebellitis Caused by Herpes Simplex Virus Type 1. CLIN INFECT DIS [online] 2003 February, 36(3):e50-e54 [viewed 30 September 2014] Available from: doi:10.1086/345781
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  7. HöFTBERGER R, SABATER L, ORTEGA A, DALMAU J, GRAUS F. Patient With Homer-3 Antibodies and Cerebellitis JAMA Neurol [online] 2013 Apr, 70(4):506-509 [viewed 01 October 2014] Available from: doi:10.1001/jamaneurol.2013.1955
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  10. SFEIR MM, NAJEM CE. Cerebellitis Associated with Influenza A(H1N1)pdm09, United States, 2013 Emerg Infect Dis [online] 2014 Sep, 20(9):1578-1580 [viewed 07 October 2014] Available from: doi:10.3201/eid2009.140160
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