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Published on: July 24, 2016
Postinfectious cerebellitis in a preadolescent child
Wenlong Zhao1, Violet Alavi2, Syed Sherazi2
1A&E, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK wenlong.zhao@wwl.nhs.uk.
Insights
Postinfectious cerebellitis, a neurological complication of varicella (chickenpox), can occur even with normal diagnostic tests. Early clinical recognition and multidisciplinary follow-up are crucial for managing this immune-mediated condition.
Area of Science:
- Neurology
- Pediatrics
- Immunology
Background:
- Varicella (chickenpox) is a common viral illness, usually self-limiting in children.
- Neurological complications, including postinfectious cerebellitis, can arise and are presumed to be immune-mediated.
- Diagnosis can be challenging due to normal initial neuroimaging and cerebrospinal fluid (CSF) findings.
Purpose of the Study:
- To report a case of postinfectious cerebellitis in a preadolescent male following varicella.
- To highlight diagnostic challenges and the importance of clinical vigilance.
- To emphasize the need for timely intervention and multidisciplinary care.
Main Methods:
- Case report of a preadolescent male presenting with ataxia and other cerebellar signs one week post-varicella rash.
- Clinical diagnosis based on neurological examination.
- Standard diagnostic workup including neuroimaging and CSF analysis, which were unremarkable.
Main Results:
- The patient exhibited classic cerebellar signs but had normal imaging and CSF results.
- Initial empirical treatment for suspected meningoencephalitis led to partial clinical improvement.
- Residual neurological deficits necessitated physiotherapy, indicating the potential for long-term impact.
Conclusions:
- Postinfectious cerebellitis can present with significant neurological deficits despite normal investigations.
- Clinical suspicion is paramount for diagnosis when faced with classic cerebellar signs post-varicella.
- Multidisciplinary follow-up and management are essential for patients with persistent neurological deficits.
Abstract:
Varicella is a common, typically self-limiting, viral illness that often occurs in childhood. However, neurological complications, such as encephalitis, vasculopathy and cerebellitis, can occur. Postinfectious cerebellitis is presumed to be immune-mediated, typically presenting within days to weeks of rash onset. Diagnosis is primarily clinical, as early neuroimaging and cerebrospinal fluid (CSF) analysis may be normal. Treatment is usually supportive, though corticosteroids or antivirals may be used in severe or atypical cases.We report a case of postinfectious cerebellitis in a preadolescent male, presenting 1 week after the resolution of varicella rash. Symptoms included ataxia, dysarthria, dysdiadochokinesia and hypertonia. Despite classic cerebellar signs, imaging and CSF analysis were unremarkable. Clinical improvement followed a short course of empirical treatment for suspected meningoencephalitis; however, residual neurological deficits persisted, necessitating physiotherapy.This case highlights the potential for significant neurological involvement in postinfectious cerebellitis despite normal investigations, underscoring the need for clinical vigilance, timely intervention and multidisciplinary follow-up.
