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Can MRI Differentiate between Infectious and Immune-Related Acute Cerebellitis? A Retrospective Imaging Study.

G Orman1, S F Kralik2, N K Desai2

  • 1From the Edward B. Singleton Department of Radiology (G.O., S.F.K., N.K.D., A.M., H.S.-H., T.A.G.M.H.), Texas Children's Hospital, Houston, Texas gxorman@texaschildrens.org.

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Summary

Acute cerebellitis is a rare neurologic condition. MR imaging can help differentiate infectious from immune-related causes, with specific findings like brainstem T2-FLAIR hyperintensity suggesting immune causes and downward herniation suggesting infectious causes.

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Area of Science:

  • Pediatric Neurology
  • Neuroradiology
  • Medical Imaging

Background:

  • Acute cerebellitis is a neurologic condition linked to infection, vaccination, or medication, characterized by cerebellar edema visible on MR imaging.
  • MR imaging aids in diagnosing anatomic abnormalities and differentiating causes of acute cerebellitis.

Purpose of the Study:

  • To evaluate MR imaging findings in pediatric acute cerebellitis.
  • To determine if MR imaging can differentiate between infectious and immune-related causes of acute cerebellitis.

Main Methods:

  • Retrospective review of electronic medical records and brain MR imaging studies from 2003-2020.
  • Analysis of demographic, clinical, and neuroimaging data for 43 pediatric patients diagnosed with acute cerebellitis.

Main Results:

  • Of 43 patients, 35 had infectious and 8 had immune-related acute cerebellitis.
  • T2-FLAIR hyperintense signal in the brainstem and supratentorial brain was more common in immune-related cases (P=.016, P=.004).
  • Downward herniation was more frequent in infectious acute cerebellitis (P=.03).

Conclusions:

  • MR imaging is valuable for diagnosing acute cerebellitis and aiding differential diagnosis.
  • Specific MR imaging findings, including T2-FLAIR hyperintensities and herniation patterns, can help distinguish between infectious and immune-related etiologies.