Differentiating Acute Infectious and Post-Infectious Cerebellitis: A Tunisian Pediatric Case Series

ABSTRACT

Background: Acute cerebellitis is the most frequent cause of acute ataxia in children. A clear definition of infectious versus post infectious cerebellitis is lacking in the literature. The outcome is usually favorable although the initial clinical picture varies greatly between patients. The aim of this study was to compare infectious versus post-infectious cerebellitis in terms of clinical features, imaging and outcome. Material(s) and Method(s) We conducted a retrospective descriptive study including patients who were hospitalized at the neuropediatrics department at the national Institute of Neurology of Tunisia, between 2005-2022, having a diagnosis of acute cerebellitis at discharge and a minimal follow-up period of six months. The SARA (Scale for Assessment and Rating of Ataxia) was used to evaluate ataxia at onset and follow-up. Symptoms of ataxia occurring alongside infectious symptoms were considered para-infectious. Result(s) A total of 37 patients were included with a sex ratio of 1,17. Post infectious cerebellitis represented 76% (28 cases). Mean age of onset was 5,79 +/- 3,74 years with no significant difference between groups. A history of infection was found in 84% of patients (31 cases) with a mean time of 7,43 +/- 6,31 days. Mean time of onset from infection was shorter in the para-infectious group (p=0,001) and concomitant fever was more frequently found (p=0,02). Onset was acute in 89% of cases in both groups. Mean SARA score at onset was 9,35 +/- 4,14 with no significant difference between groups. Aetiology was unknown in 51% of cases (19 patients). Two covid-19 related cerebellitis were noted both in the para-infectious group. No difference between groups in terms of imaging or cerebral spinal fluid analysis was noted. There were no sequalae in 78% and 89% of cases in the post-infectious and para-infectious groups respectfully and no difference in terms of outcome or SARA score at follow-up was noted. Conclusion(s) In our cases series, significant differences were noted between the post-infectious and para-infectious cerebellitis subgroups. Mean time of onset from infectious episode was shorter and fever was more frequent in the para-infectious group. A clear definition of para-infectious cerebellitis is needed in order to determine the real proportion of this entity and allow a better management.Copyright © 2022