Fulminantni cerebelitis kao rijetka komplikacija uobičajene infekcije: izazov u pedijatriji

Introduction: Acute cerebellitis is a rare inflammatory disease with a variable course, from a benign self-limiting condition with minimal symptoms to fulminant cerebellitis associated with a high risk of morbidity and mortality. The etiology of the disease is most often infectious or post-infectious, and rotavirus has been described as one of the possible causes. Complications of the disease are the result of acute cerebellar edema that compresses the structures of the posterior cranial fossa and brainstem and leads to the development of obstructive hydrocephalus, intracranial hypertension with impaired consciousness up to status epilepticus, and a fatal outcome due to herniation of the cerebellar tonsils. Children usually have generalized symptoms with nausea, headache, rapid impairment of consciousness, and later mutism. Pleocytosis is present in the cerebrospinal fluid, and brain imaging studies show progressive, significant cerebellar atrophy. If not treated promptly, death can occur. Case report: We present a 6-year-old girl admitted to the Children's Hospital Zagreb with acute ataxia and somnolence. On admission, the Glasgow Coma Scale (GCS) was 13/15. The evening before admission, she vomited 3-4 times, had dyskinesias, was irritable, and made unusual noises. Initial laboratory findings, electroencephalogram, and magnetic resonance imaging (MRI) were normal. Within 12 hours, she developed progressive impairment of consciousness to coma (GCS 5), was intubated, and transferred to the Intensive Care Unit. Repeated MRI scans showed the development of diffuse cerebellitis, hypertensive hydrocephalus, and encephalitis, which were treated with acyclovir, ceftriaxone, intravenous immunoglobulins, and corticosteroids, and external cerebrospinal fluid drainage. The clinical picture was further complicated by the occurrence of recurrent epileptic seizures and the development of status epilepticus, which were treated with levetiracetam and midazolam. After three weeks, all of the above changes regressed. After two months, she was discharged from the hospital for inpatient rehabilitation with a very slow recovery and dominant mutism. A slight improvement in neurological status was gradually noted (GCS 9). Five months after the onset of the disease, with home physical therapy, the girl made significant progress, walking and speaking (GCS 14). She recovered completely. Conclusion: The presented case of fulminant cerebellitis as a rare complication of a common infection emphasizes the importance of early recognition of the disease, repeated neuroradiological examinations, and timely and intensive therapy. Despite the severe initial clinical picture and numerous complications, with adequate treatment and rehabilitation, a full recovery is possible.