Presented by Min Jie Lee, MD (PGY-1)
Acute post-infectious cerebellar ataxia (APCA):
- Postinfectious (mostly viral) cerebellitis that is a pure pan-cerebellar syndrome w/o other signs of CNS infection.
- In young children, most common preceding infection is varicella.
- Often w/ normal MRI scan
- Diagnosis of exclusion
- Self-limited, often recovery within 2 weeks
- May occur after a systemic illness or be the direct result of infection in the cerebellum.
- Signs & symptoms beyond pure cerebellar syndrome –may include altered sensorium and manifestations of raised intracranial pressure
- Often with abnormal MRI
- Drug ingestion
- Posterior fossa tumor
- Meningitis / encephalitis
- Brainstem encephalitis
- Acute demyelinating encephalomyelitis (ADEM)
- Neuroblastoma (opsoclonus-myoclonus syndrome)
- Guillan-Barre syndrome
- Trauma: contusion or hemorrhage, vertebrobasilar dissection
- If acute onset of ataxia (pure cerebellar syndrome) and recent viral illness, high likelihood of APCA → no imaging indicated
- If cerebellar symptoms AND headache, fever, nuchal rigidity, altered mental status, nausea, LOC, or seizures → CT/MRI to rule out AC or other concerning diagnoses
- Prognosis is good for both
- Several case reports on steroids used to treat moderate-severe acute cerebellitis.
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