Acute hemiataxia in childhood

Acute hemiataxia is a rare condition in childhood. Infectious, postinfectious, traumatic, neoplastic, and vascular reasons have to be considered in the differential diagnosis of acute hemiataxia.

We report the case of a 5-year-old girl with initial symptoms of acute hemiataxia, dysarthria, and hemiparesis. She was ill since 7 days with fever. Five days before a urinary infection was diagnosed and she was treated with a cephalosporin. On the day of admission, she presented with the symptoms of acute hemiataxia, dysarthria, and hemiparesis. The computed tomography (CT) of the brain and the cerebrospinal fluid (CSF) sample at admission were normal. The magnetic resonance imaging (MRI) of the brain showed a hemicerebellitis with high T2-weighted and flair-weighted signal.

Our patient showed a good clinical outcome without specific interventions. The CSF sample and blood sample could not prove a postinfectious or viral cause. Serologic tests for Borrelia burgdorferi, herpes simplex virus type I and II, varicella zoster, mumps, cytomegalovirus, coxsackievirus, and enterovirus were negative.

Six months later, there was only a slight lack of motor coordination in the remaining left hand. The clinical outcome correlated with the hemiatrophy of the cerebellar cortex in the control MRI.

Only a few cases of acute hemicerebellitis have been published in the literature. In most case reports of hemicerebellitis, a good prognosis is described. Sometimes, however, there is a risk of mass-compressing of the fourth ventricle, which needs surgical decompression in cerebellitis and hemicerebellitis. The long-term outcome is only analyzed in cerebellitis. Neurological sequelae, cognitive sequelae, and atrophy of the cerebellum are described in follow-up studies in the literature. On the assumption that hemicerebellitis is an exceedingly rare unilateral presentation of acute cerebellitis, a long-term follow up of these patients is also necessary.