438 - A Rare Case of Acute Post-Infectious Cerebellitis: A Case Report

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

VT

Vincent Thieu, BSE

Medical Student
Michigan State University College of Human Medicine
Troy, Michigan, United States

Co-Author(s)

DC

Deanna Claus, MD

Resident Doctor
University of Colorado
Denver, Colorado, United States
EG

Emily A. Gianetti, MD

Resident
University of Colorado
Greenwood Village, Colorado, United States
KP

Katherine G. Payne, MD

Associate Professor of Clinical Physical Medicine & Rehabilitation
University of Colorado Hospital
Denver, Colorado, United States
William Niehaus, MD (he/him/his)

Associate Program Director of CU Physical Medicine and Rehabilitation Residency
CU Physical Medicine and Rehabilitation Residency
Denver, Colorado, United States

Case Diagnosis: Post-infectious cerebellitis

Case Description: A previously healthy 21-year-old male presented to an acute care hospital with progressive neurologic symptoms over 2-3 weeks. He initially experienced viral symptoms and later developed diplopia, dysarthria, and ataxia. He was treated empirically for meningitis, followed by intravenous corticosteroids. However, he returned a week later with worsening dysarthria, weakness, and new hyporeflexia. He was readmitted for intravenous immunoglobulin treatment due to concerns about Miller-Fisher Syndrome. Despite treatment, there was no improvement, so he was transferred to a tertiary care center for further evaluation and workup. T2-FLAIR Brain MRI showed diffuse enhancement of the cerebellum, which raised concerns about an infectious or inflammatory process. He was given more steroids and transferred to rehabilitation. However, he was readmitted to neurology for acutely worsening dysarthria and received 5 days of plasmapheresis and cyclophosphamide. After treatment, he returned to the rehabilitation service and made significant gains with therapy, particularly with speech and coordination.

Discussions: This case represents a rare occurrence of post-infectious cerebellitis, as most cases are described in children. This patient’s rehabilitation course was complicated by persistent neurologic deficits, including his vision and coordination challenges. It is imperative for regular evaluation of these potential discharge obstacles and red flag symptoms of sudden increase in dysarthria, alterations in vision or speech, weakness, or challenges with walking.

Conclusions: Diagnosis and management of acute cerebellitis can be complex. Interdisciplinary rehabilitation is essential to facilitate recovery and improve functional independence prior to discharge.