Unusual Cause of White Cerebellum

Excerpt

To the Editor: A 2-y-old boy presented with fever, irritability and inability to speak for 3 d. There was no history of seizures, focal motor deficit, and cranial nerve involvement. History of gastroenteritis like illness was present 15 d back. There was no history suggestive of rash, cough, neck swelling, trauma and ear discharge. On examination, he had normal anthropometric parameters, mild irritability, normal fundus, mutism, down beat nystagmus, intentional tremors, dysmetria, and central hypotonia. A diagnosis of acute infectious cerebellitis was thought of and child was started on intravenous ceftriaxone, acyclovir, and oral azithromycin. Cerebrospinal fluid examination (CSF) showed lymphocytic pleocytosis (29 cells, 74 mg/dl protein and 62 mg/dl sugar). Contrast enhanced computerized tomography (CECT) showed white cerebellum or reversal sign with mild supratentorial hydrocephalus (Fig. 1a, b). Magnetic resonance imaging (MRI) of brain was suggestive of acute cerebellitis (Fig. 2a–c). He was started on oral acetazolamide and intravenous methyl prednisolone (30 mg/kg/d) for 5 d along with antibiotics. At 2 mo follow up, he was asymptomatic with normal central nervous system examination.

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