Case report of prenatal bilateral cerebellar infarction: implications for social-behavioral functioning

Objective: Complete prenatal cerebellar infarction is rare and few reports exist documenting developmental outcomes. We report outcome data on a child who sustained a stroke to the bilateral cerebellar hemispheres at 25 weeks gestation, and was subsequently seen for follow-up neuropsychological evaluations at ages 5 years, 5 months and 7 years, 9 months. Method: Retrospective chart review. Results: Findings from the initial evaluation at age 5 were consistent with a diagnosis of intellectual disability based on developmental testing and parent-reported adaptive behavior. Deficits in social communication, relatedness, and reciprocity were identified, though diagnosis of an autism-spectrum disorder (ASD) was deferred given the difficulty of interpreting these findings in the context of his physical and cognitive disabilities. Re-assessment at age 7 included comprehensive autism assessment, and a diagnosis of ASD was confirmed. Neuropsychological testing revealed minimal developmental skill progression over the assessment interval. Conclusions: These findings add to growing evidence that the cerebellum plays an important role in social development, and that early cerebellar injury may represent an acquired pathway for ASD. Complex medical histories may obscure or delay diagnosis of ASD, highlighting the importance of early evaluation using a multidisciplinary approach.