412 - Post-infectious acute cerebellar ataxia, a case of acute ataxia in a previously healthy pediatric patient

Case Diagnosis: 8 year old female with 2 weeks of acute onset ataxia, dysarthria, vertigo, vomiting. Diagnosed with post-infectious antibody mediated inflammatory cerebillitis.

Case Description: 8 year old previously healthy female presented to the hospital after several days of ataxia, nausea, vomiting, fatigue. Initial differential included labyrinthitis, otitis media, meningitis, and viral illness. She was initially placed on ampicillin for prophylactic meningitis treatment but patient’s course continued to regress. Extensive Infectious and neurological work up including; Lumbar Puncture, Covid 19, EBV, CMV, EEG, CT were unremarkable for etiology. MRI noting only non-specific increased meningeal enhancement. The clinical diagnosis of post-infectious/para-infectious antibody mediated inflammatory cerebillitis was made by Peds Neurologist. Subsequently started on 4 mg/kg of prednisolone with significant improvement in symptomatology. Working with therapies, she progressed to independent ambulatory from Max A on initial evaluation.

Discussions: Acute onset ataxia is an uncommon presenting complaint in children. While rare, it is crucial to keep Acute cerebellitis in the differential, which is a rare inflammatory disease that is often a careful clinical diagnosis by exclusion and has a wide range of presentations, from benign disease course to fatal. Severe cases can result in changes seen on MRI such as demyelination of the cerebellum or diffuse t2 hyperintensities/swelling, leading to obstruction of ventricles, hydrocephalus and tonsillar herniation (Steinlin, 2012). For more mild to moderate cases like this one, progression with steroid treatment and rehabilitative therapies supports a good prognosis.

Conclusions: This case outlines the importance of collaboration with Pm & R physicians and neurologists with uncommon neurological complaints such as acute ataxia in a child. This patient had an excellent functional recovery once properly diagnosed after both steroid treatment and rehabilitative therapies.

Reference: Reference 1: The Continuum of Parainfectious Reactions of the Cerebellum in Childhood Maja Steinlin, 1Department of Neuropaediatrics, University Children’s Hospital, Bern, Switzerland Neuropediatrics 2012;43:238–239.