Case Report
Acute pseudotumoral hemicerebellitis: Diagnosis and neurosurgical considerations of a rare entity

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Abstract

Acute pseudotumoral hemicerebellitis is an exceptionally rare unilateral presentation of acute cerebellitis mimicking a tumor. It typically has a benign course without specific therapy; thus, recognizing this entity is important to avoid needless surgical intervention. MRI provides the key for diagnosis and usually reveals a diffusely swollen cerebellar hemisphere with no well-defined mass. Some patients will require neurosurgical assistance by means of ventriculostomy or posterior fossa decompression. We present a 17-year-old girl with pseudotumoral hemicerebellitis, review the available literature, and discuss the diagnosis and therapeutic dilemma from the neurosurgical perspective.

Introduction

Acute pseudotumoral hemicerebellitis is a very rare presentation of cerebellitis in children. Patients may present with a variety of symptoms, ranging from headaches to cranial nerve palsies that are attributable to ventricular or brainstem compression. MRI can assist in excluding a tumor and establishing a diagnosis of acute cerebellitis based on the absence of a well-defined mass and the presence of pial enhancement along the cerebellar folia, together with a hyperintense T2 signal, and a hypointense T1 signal abnormality.

Most patients recover from acute cerebellitis without specific treatment, although antiviral medications, steroids, and mannitol are administered in some patients.1, 2 Close monitoring is usually advised due to the potential for cerebellar swelling that may result in compression of the fourth ventricle and obstructive hydrocephalus requiring ventriculostomy or posterior fossa decompression.3, 4 We report a pediatric patient with acute hemicerebellitis that resembled a tumor on imaging studies, review the available literature, and focus the discussion from a neurosurgical perspective.

Section snippets

Case report

A 17-year-old girl was admitted to our hospital with a history of headaches, dizziness, gait imbalance, and recurrent episodes nausea and vomiting. Two weeks earlier she had developed an extensive cutaneous rash but no fever. At admission, the patient was febrile, oriented, and conscious. She complained of headaches and dizziness. Her neurological examination revealed nystagmus with left dysmetria and adiadochokinesis, as well as findings compatible with left hemispheric cerebellar syndrome. No

Discussion

Acute cerebellitis is one of the major causes of cerebellar dysfunction in children and adolescents. It may result from viral or autoimmune etiologies and has a benign course in the majority of patients, as was seen in our patient.

Hemicerebellitis is considered rare,5, 6 and pseudotumoral hemicerebellitis as described in this report is exceptionally rare.7, 8, 9 Although hemorrhage is not a recognized feature of the disease, pseudotumoral hemicerebellitis with hemorrhage was recently reported

Conflict of interest/disclosure

The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.

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