Acute cerebellitis with fatal and near-fatal course

Acute cerebellitis is a rare infectious or postinfectios disorder of the central nervous system in children. We present 5 children (3 girls, 2 boys with an age of 23 m to 14 y) with fatal and near-fatal courses of acute cerebellitis. Initial clinical symptoms were occipital headache and vomiting. Three children suffered from a respiratory tract infection, two developed a respiratory arrest. CT and MRT showed swelling of the cerebellum and 2^nd infarctions. In one case enterovirus could be demonstrated by CSF PCR. One child each showed serological evidence of HSV1, EBV and mycoplasma pneumonia infection. One child who underwent lumbar puncture in spite of a pathological CT scan died due to cerebellar herniation. One child with enlarged ventricles was treated with an external CSF drainage. Of the 4 surviving children, 2 suffer from severe and 1 from moderate sequelae.

Irrespective of the aetiology, acute cerebellitis may lead to a life threatening neurological emergency and needs to be diagnosed early. If symptoms and signs suggestive of cerebellitis and raised intracranial pressure are present, cerebral imaging should be performed before lumbar puncture. Besides causative antimicrobial therapy, corticosteroids and immunomodulatory therapies, external CSF drainage and decompression of the posterior fossa have to be considered.