Postenfeksiyöz Serebellar Ataksi ve Serebellit
Özet
Akut serebellar ataksi, genellikle viral enfeksiyonlar sonrası gelişen, ani başlangıçlı yürüme bozukluğu ve denge kaybı ile karakterize, çocukluk çağında sık görülen benign bir klinik tablodur. Akut serebellit ise benzer semptomlarla seyretmekle birlikte, MRG'de serebellar inflamasyon bulgularının varlığı ile ayırt edilen, bazen daha ağır komplikasyonlara yol açabilen patofizyolojik bir durumdur. Tanıda detaylı anamnez ve fizik muayene temel rol oynarken, tedavi süreci genellikle destekleyicidir ancak ağır vakalarda steroid gibi medikal müdahaleler gerekebilir. Çoğu hasta kısa sürede tam iyileşme gösterse de, nadiren fulminan seyir ve hayati risk taşıyan komplikasyonlar görülebilir.
Acute cerebellar ataxia is a common, generally benign pediatric condition characterized by the sudden onset of gait instability and tremors, typically following viral infections. Acute cerebellitis presents with similar symptoms but is distinguished by visible inflammatory findings on MRI and a potentially more severe clinical course, including risks like obstructive hydrocephalus. Diagnosis relies primarily on careful clinical evaluation and medical history, while management is largely supportive, although severe cases may require steroid therapy. Most children experience full recovery within a few months, though clinicians must remain vigilant for rare, life-threatening complications.
Referanslar
Marc Tardieu MJ. Para-infectious and other inflammatory disorders of immunological origin; 2008.
Caffarelli M, Kimia AA, Torres AR. Acute ataxia in children: a review of the differential diagnosis and evaluation in the emergency department. Pediatric neurology 2016; 65: 14-30.
Emelifeonwu JA, Shetty J, Kaliaperumal C, et al. Acute cerebellitis in children: a variable clinical entity. Journal of child neurology 2018; 33(10): 675-84.
Sawaishi Y, Takada G. Acute cerebellitis. The Cerebellum 2002; 1(3): 223-8.
Ryan MM, Engle EC. Topical review: acute ataxia in childhood. Journal of child neurology 2003; 18(5): 309-16.
Nussinovitch M, Prais D, Volovitz B, Shapiro R, Amir J. Post-infectious acute cerebellar ataxia in children. Clinical pediatrics 2003; 42(7): 581-4.
Tardieu M, Banwell B, Wolinsky JS, Pohl D, Krupp LB. Consensus definitions for pediatric MS and other demyelinating disorders in childhood. Neurology 2016; 87(9 Supplement 2): S8-S11.
Odaka M, Yuki N, Yamada M, et al. Bickerstaff’s brainstem encephalitis: clinical features of 62 cases and a subgroup associated with Guillain–Barré syndrome. Brain 2003; 126(10): 2279-90.
Wolf VL, Lupo PJ, Lotze TE. Pediatric acute transverse myelitis overview and differential diagnosis. Journal of child neurology 2012; 27(11): 1426-36.
Tate ED, Allison TJ, Pranzate MR, Verhu SJ. Neuroepidemiologic trends in 105 US cases of pediatric opsoclonus-myoclonus syndrome. Journal of Pediatric Oncology Nursing 2005; 22(1): 8-19.
Desai J, Mitchell WG. Acute cerebellar ataxia, acute cerebellitis, and opsoclonus-myoclonus syndrome. Journal of child neurology 2012; 27(11): 1482-8.
ÜNVER O, KUTLUBAY B, THOMAS G, ELDEŞ HACİFAZLİOĞLU N, SAĞER G, TÜRKDOĞAN D. Postinfectious Acute Cerebellar Ataxia in Childhood. Journal of Clinical and Analytical Medicine 2016; 7(5): 652-5.
Bozzola E, Bozzola M, Tozzi AE, et al. Acute cerebellitis in varicella: a ten year case series and systematic review of the literature. Italian journal of pediatrics 2014; 40(1): 1-5.
Dale RC, Vincent A. Inflammatory and autoimmune disorders of the nervous system in children: John Wiley & Sons; 2010.
Yildirim M, Gocmen R, Konuskan B, Parlak S, Yalnizoglu D, Anlar B. Acute cerebellitis or postinfectious cerebellar ataxia? Clinical and imaging features in acute cerebellitis. Journal of child neurology 2020; 35(6): 380-8.
Fadakar N, Ghaemmaghami S, Masoompour SM, et al. A first case of acute cerebellitis associated with coronavirus disease (COVID-19): a case report and literature review. The Cerebellum 2020; 19(6): 911-4.
Levy EI, Harris AE, Omalu BI, Hamilton RL, Branstetter IV BF, Pollack IF. Sudden death from fulminant acute cerebellitis. Pediatric neurosurgery 2001; 35(1): 24-8.
van Toorn R, Georgallis P, Schoeman J. Acute cerebellitis complicated by hydrocephalus and impending cerebral herniation. Journal of child neurology 2004; 19(11): 911-3.
Kornreich L, Shkalim-Zemer V, Levinsky Y, Abdallah W, Ganelin-Cohen E, Straussberg R. Acute cerebellitis in children: a many-faceted disease. Journal of child neurology 2016; 31(8): 991-7.
Lechón FC, Rodríguez AD, Cerdá SIS, et al. Hemicerebellitis: report of three paediatric cases and review of the literature. european journal of paediatric neurology 2014; 18(3): 273-81.
Sener U, Eidelman B. A Case of Post-EBV Cerebellitis Treated with IVIG (P2. 322). AAN Enterprises; 2017.
D'Ambrosio E, Khalighinejad F, Ionete C. Intravenous immunoglobulins in an adult case of post-EBV cerebellitis. BMJ Case Reports CP 2020; 13(2): e231661.
Hughes H, Kahl L. The Harriet Lane handbook: a manual for pediatric house officers: Elsevier; 2018.
Kimberlin DW. Acyclovir Dosing in the neonatal period and beyond. Journal of the Pediatric Infectious Diseases Society 2013; 2(2): 179-82.
Salas AA, Nava A. Acute cerebellar ataxia in childhood: initial approach in the emergency department. Emergency Medicine Journal 2010; 27(12): 956-7.
