Generality
The cerebellitis, or acute cerebellar ataxia, is a disease that appears due to an inflammation of the cerebellum and which determines the dysfunction of the latter.
Due to infections, vaccination practices, haemorrhages in the cerebellum, stroke, vitamin deficiencies etc., the cerebellitis is responsible for disorders such as: unstable gait, lack of coordination between the movements of the trunk and those of the limbs, tendency to stumble, nystagmus, dysarthria, nausea, vomiting, headache, tremors and dizziness. Moreover, in the most serious cases, it can lead to complications, the outcome of which is sometimes fatal for the patient.
The diagnosis of cerebellitis is based on: an in-depth analysis of symptoms, medical history, neurological evaluation, blood and urine tests, radiological examinations related to brain, nerve conduction studies, electromyography and rachicentesis.
The cerebellitis mainly requires a causal treatment, that is a therapy aimed at breaking down the triggering cause.
Short review of what is the cerebellum?
The cerebellum is one of the main components of the brain, ie the organ, together with the spinal cord, constitutes the central nervous system.
Located in the posterior part of the brain (in the so-called posterior cranial fossa), the cerebellum is an ovoid-shaped structure, weighing about 130-140 grams, in which it is possible to recognize two lateral expansions - called cerebellar hemispheres - divided by a line central median - called vermis .
Equipped with a gray substance (the so-called cerebellar cortex) and white substance (in which the cerebellar nuclei reside), the cerebellum plays a key role in learning, motor control, coordination of voluntary muscles, in the sense of balance and, finally, in some cognitive functions related to language and attention.
What is Cerebellite?
The cerebellite, also known as acute cerebellar ataxia, is a disease that arises as a result of an inflammatory process affecting the cerebellum and which alters its functions, especially with regard to motor control and coordination of voluntary muscles.
The cerebellitis is a pathology that arouses great interest especially among parents of children under 10 years of age, as these subjects represent its preferred targets.
Meaning of acute cerebellar ataxia
- The term " ataxia " indicates a group of diseases characterized by a progressive loss of the ability to control voluntary muscles, followed by an inability to coordinate them.
- The term " cerebellar " is the adjective that refers to the cerebellum.
- The term " acute " indicates that the symptoms of cerebellar ataxia appear abruptly and very quickly, within a few hours / days.
Epidemiology
At the general population level, the cerebellitis is a rare disease .
As anticipated, he has a predilection for young people under the age of 10; however, even if it happens very often, it can also affect adults.
Among the youngest, those aged between 2 and 7 years are the most affected by cerebellitis.
Causes
Usually, the cerebellitis appears following a primary or secondary infection ; less frequently, it is subsequent to a vaccination practice or to other very special events.
In both circumstances, however, it plays the role of complication, that is, the condition resulting from an aggravation of the present pathology or an event just happened.
What infections are causing cerebellitis?
Infectious agents potentially capable of causing cerebellitis include:
- The influenza virus;
- The Epstein-Barr virus;
- The Coxsackie virus;
- The Echovirus;
- Hepatitis A virus;
- Herpes Simplex Virus I;
- Human Herpes Virus 6;
- The measles virus;
- Rubella virus;
- Mumps virus;
- Parvovirus 19;
- Some Enteroviruses;
- The bacterium Mycoplasma Pneumoniae, which is the main causative agent of atypical pneumonia;
- The bacterium Borrelia Burgdorferi, which is the causative agent of Lyme disease;
- The bacterium Salmonella Typhi, which is the causative agent of typhoid fever.
It is important to note that only in rare cases these infectious agents trigger an inflammatory process on the cerebellum and result in cerebellitis.
What vaccines are causing cerebellitis?
Vaccinations that can lead to cerebellitis include: the rabies vaccine (ie the rabies vaccine), the varicella vaccine and the hepatitis B vaccine .
What other special events cause cerebellitis?
The "special events that can cause cerebellitis" include: bleeding at the level of the cerebellum, exposure to mercury or lead, brain traumas involving the cerebellum, episodes of stroke at the level of the cerebellum and some vitamin deficiencies (eg : lack of vitamin B-12, vitamin B-1 or vitamin E).
Symptoms and Complications
The cerebellite symptoms usually appear abruptly and quickly.
The most important manifestations of acute cerebellar ataxia include:
- Lack of motor coordination between trunk and upper limbs or between trunk and lower limbs ( truncal ataxia );
- Unsteady gait;
- Tendency to stumble;
- Tremors;
- nystagmus;
- Headache, nausea and vomiting;
- Dizziness;
- Difficulty eating;
- Speaking language ( dysarthria ).
Did you know that ...
Cerebellitis is the most common cause of unsteady gait in children under 10 years.
Post-infectious cerebellitis: after what has appeared?
The most common form of cerebellitis - that is, the post-infectious cerebellitis - arises, always in abrupt mode, after 2-3 weeks from the triggering infection.
When are the symptoms permanent?
When the cerebellitis depends on a stroke episode, a hemorrhage or a non-viral infection, the consequent symptoms could be permanent (the therapy could only induce an improvement).
Curiosity
In children and adults, the cerebellitis differs not so much from the symptoms (these tend to coincide in the two categories of patients), but rather from the triggering causes. Infection is the most common causative factor in young people, whereas in adults it is a circumstance such as, for example, exposure to mercury or lead and episodes of stroke in the cerebellum.
Complications
From severe cerebellitis may arise important complications, sometimes fatal, including: cerebellar tonsil hernia (protrusion in the cervical canal of one or both cerebellar tonsils), obstructive hydrocephalus combined with intracranial hypertension and severe cerebellar atrophy .
Furthermore, seeing themselves unable to perform the same motor gestures as healthy people, some patients with cerebellitis develop states of depression or low mood over time, which further compromise their quality of life.
When should I go to the doctor?
Especially in a young individual who has just recovered from one of the aforementioned cerebellitis-related infections, it is a valid reason to immediately contact a doctor or go to the nearest hospital center for the apparently unjustified appearance of disorders, such as: unsteady gait, lack of coordination between trunk and limbs, and a tendency to stumble.
Diagnosis
In general, to formulate the diagnosis of cerebellitis and understand its causes, they are fundamental:
- The patient's or parent's account of symptoms (the second circumstance is more likely, given that the cerebellitis is a disease with a predilection for young individuals);
- Physical examination and medical history . They consist in a critical study of symptoms and in a research, through specific questions to the patient (or, if the patient is young, to the parents of the latter), of the possible causes triggering the condition in progress.
For example, it is through the anamnesis that doctors learn about the most recent infections, possible head injuries, the most recent vaccination practices, etc.
- An accurate neurological evaluation . It is used to understand the state of health of the nervous system.
In performing it, the doctor analyzes reflexes, coordination, balance, motor skills, sight, hearing and memory skills.
- The study of nerve conduction and electromyography . The first test evaluates the functioning of the nerves (whether it is correct or not); the second test, instead, allows us to estimate the quality of the control of voluntary muscles by the nervous system.
- CT scan or magnetic resonance imaging (NMR) to the brain. By providing both clear images of the brain, they allow doctors to assess their health and identify damage, alterations and / or other abnormalities.
- The rachicentesi (or lumbar puncture ). It consists in taking some of the cerebrospinal fluid and in its subsequent laboratory analysis.
It is a test that allows the identification of infectious agents at the level of the nervous system.
- Blood tests and urinalysis . They serve to further investigate the patient's state of health.
Importance of differential diagnosis
For the purpose of identifying a disease like the cerebellite, the differential diagnosis plays a key role, namely the diagnostic approach centered on the exclusion of all those pathologies with similar symptoms (in this specific case, to acute cerebellar ataxia).
Among the tests useful for the differential diagnosis, there are: CT and MRI of the brain, blood tests, urinalysis and rachicentesis.
Therapy
The cerebellite requires a causal therapy, ie a treatment aimed at breaking down the triggering cause. Obviously, a similar type of therapeutic approach implies that the treatment adopted varies from patient to patient, depending on the condition that supports acute cerebellar ataxia.
Where the cerebellitis has caused damage to the cerebellum, the use of symptomatic therapy, ie a treatment aimed at alleviating the symptomatology, could also be indispensable.
The need for causal therapy in the presence of cerebellitis justifies the long series of diagnostic tests, aimed at establishing with precision the causes of the ongoing inflammation.
Some examples of treatment for cerebellitis
- If the cerebellitis is due to a viral infection (varicella, rubella etc.), no particular treatment is foreseen, except to have the patience to wait for the spontaneous resolution of the symptomatology, spontaneous resolution that occurs in a few weeks.
- If the cerebellitis is the result of hemorrhage at the level of the cerebellum, the patient must undergo surgery to stop the loss of blood and eliminate the bleeding portion.
In such circumstances, timely action reduces the risk of permanent damage to the cerebellum.
- If the cerebellitis is the consequence of a stroke at the level of the cerebellum, the patient must undergo an anticoagulant drug therapy, for the fluidization of the blood.
- If the cerebellitis is due to bacterial infection, the therapy involves the use of antibiotics.
Timely use of antibiotics is essential to avoid unpleasant consequences.
- If the cerebellitis results from exposure to a certain toxic substance (eg: mercury), the patient benefits from evading the aforementioned exposure.
- If the cerebellitis is due to a vitamin deficiency (eg: vitamin B-12 deficiency), the therapy involves the administration of high doses of the deficient vitamin.
Symptomatic therapy in the case of cerebellitis
The list of symptomatic treatments useful in some specific cases of cerebellitis includes: physiotherapy, logotherapy and occupational therapy .
Prognosis
The prognosis in the case of cerebellitis depends on the triggering cause: in the presence of a causal factor that is not particularly relevant from the clinical point of view (eg: viral infection), the prognosis tends to be positive; on the contrary, in the presence of a clinically important causal factor, the prognosis has a good chance of being ominous, due to the onset of complications sometimes with a fatal outcome.
Prevention
Preventing post-infectious cerebellitis is complex, if not, in some cases, even impossible; instead, prevention against the cerebellite due to stroke or exposure to toxic materials is already more feasible, as it is easier to control the triggers.
Example of how to prevent stroke cerebellitis
Leading a lifestyle, regularly exercising, controlling hypertension and keeping blood cholesterol levels under control are the cornerstones for preventing cerebellitis related to stroke episodes.
