Neurology

Answer 1 Acute postinfectious cerebellitis. When following a viral infection by 10 to 14 days, onset of cerebellar symptoms (maximal within a few hours) is typical of acute postinfectious cerebellitis.1,2 In this condition, the sensorium should remain clear. MRI of the brain may show increased T2 intensities in the cerebellum. Improvement should begin within a few days of onset, and gait should normalize within 1 to 5 months. The rapidity of symptom onset distinguishes this condition from medulloblastoma and FRDA. This child’s preserved reflexes and absence of ophthalmoplegia distinguish this condition from the Miller Fisher variant of Guillain-Barré syndrome. Multiple sclerosis involves recurrent attacks with evidence of central demyelination and would not be diagnosed with a first episode. REFERENCES 1. Fenichel GM. Clinical pediatric neurology: a signs and symptoms approach. Philadelphia: WB Saunders; 1997. 2. Montenegro MA, Santos SL, Li LM, Cendes F. Neuroimaging of acute cerebellitis. J Neuroimaging 2002;12:72-4. Click here to return to the questions

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