Download PDF
CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(11): 1047-1048
DOI: 10.1590/0004-282X-ANP-2021-0145
Images in Neurology

Acute hemicerebellitis in a young adult: a potential pitfall

Hemicerebelite aguda em adulto jovem: uma armadilha em potencial
Pedro Henrique Almeida Fraiman 
1   Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
2   Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Divisão de Radiologia, Natal RN, Brazil.
,
Manuel Moreira-Neto 
3   Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Divisão de Neurologia, Natal RN, Brazil.
,
Clecio Godeiro-Junior 
2   Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Divisão de Radiologia, Natal RN, Brazil.
› Author Affiliations
› Further Information
Also available at
 
 PDF Download Permissions and Reprints

A 20-year-old man presented with a new headache for 21 days. His neurological examination showed mild right-side ataxia while walking in tandem. Brain MRI revealed extensive hyperintensities in the right cerebellar hemisphere in FLAIR/T2WI and moderate choline peak and low NAA ([Figure 1]). The viral and rheumatological panels in serum were negative. After 8 months, there was lesion regression ([Figure 2]). Combined lesion evolution and spectroscopy findings, inflammatory nature was suggested.

Zoom Image
Figure 1 Acute hemicerebellitis neuroimaging features. (A, B) FLAIR/T2WI of posterior fossa revealing extensive hyperintensity area in right cerebellar hemisphere, mainly in posterior and lateral portions, with mild expansive effect; (C) GRE/T1WI showing increased vascular enhancement after contrast, suggesting hyperemia. (D) Multivoxel Proton MRI spectroscopy (long time of 144 ms) presenting high Choline peak, low lactate peak, low NAA and myo-inositol. High choline is not expected in Lhermitte-Duclos syndrome, as seen in this case, helping the differential diagnosis. (E, F) Cerebral Blood Flow (CBF) and Cerebral Blood Volume (CBV), respectively, increase in the right cerebellar hemisphere compared to the left hemisphere.
Zoom Image
Figure 2 Follow-up study after 8 months. (A, B, C) Follow-up study after 8 months revealing regression of previous alterations and a mild cortical atrophy in lateral and superior right cerebellar hemisphere (thick arrows). Regression of lesions with mild atrophy is compatible with natural evolution of hemicerebellitis in opposition of progressive lesions (e.g. tumors).

The diagnosis of hemicerebellitis is uncommon in adults but more common in children[1]. Spectroscopy could help differentiate from mimicking neoplastic lesions (e.g., Lhermitte-Duclos syndrome)[2] and avoid unnecessary interventions.


#

Conflict of interest:

There is no conflict of interest to declare.

Authors’ contributions:

PHAF: analysis and interpretation, writing and drafting the manuscript; MMN, CGJ: critical revision of the manuscript for intellectual content.


  • REFERENCES

  • 1 Suzuki K, Nakamura T, Numao A, Fujita H, Komagamine T, Nagashimi T, et al. Acute hemicerebellitis in a young adult: a case report and literature review. J Neurol Sci. 2014 Dec 15;347(1-2):364-7. https://doi.org/10.1016/j.jns.2014.10.016
  • 2 Guerrini L, Belli G, Cellerini M, Nencini P, Mascalchi M. Proton MR spectroscopy of cerebellitis. Magn Reson Imaging. 2002 Oct;20(8):619-22. https://doi.org/10.1016/S0730-725X(02)00600-8

Address for correspondence

Pedro Henrique Almeida Fraiman

Publication History

Received: 12 April 2021

Accepted: 03 June 2021

Article published online:
04 July 2023

© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

  • REFERENCES

  • 1 Suzuki K, Nakamura T, Numao A, Fujita H, Komagamine T, Nagashimi T, et al. Acute hemicerebellitis in a young adult: a case report and literature review. J Neurol Sci. 2014 Dec 15;347(1-2):364-7. https://doi.org/10.1016/j.jns.2014.10.016
  • 2 Guerrini L, Belli G, Cellerini M, Nencini P, Mascalchi M. Proton MR spectroscopy of cerebellitis. Magn Reson Imaging. 2002 Oct;20(8):619-22. https://doi.org/10.1016/S0730-725X(02)00600-8

   Permissions and Reprints
Zoom Image
Figure 1 Acute hemicerebellitis neuroimaging features. (A, B) FLAIR/T2WI of posterior fossa revealing extensive hyperintensity area in right cerebellar hemisphere, mainly in posterior and lateral portions, with mild expansive effect; (C) GRE/T1WI showing increased vascular enhancement after contrast, suggesting hyperemia. (D) Multivoxel Proton MRI spectroscopy (long time of 144 ms) presenting high Choline peak, low lactate peak, low NAA and myo-inositol. High choline is not expected in Lhermitte-Duclos syndrome, as seen in this case, helping the differential diagnosis. (E, F) Cerebral Blood Flow (CBF) and Cerebral Blood Volume (CBV), respectively, increase in the right cerebellar hemisphere compared to the left hemisphere.
Zoom Image
Figure 2 Follow-up study after 8 months. (A, B, C) Follow-up study after 8 months revealing regression of previous alterations and a mild cortical atrophy in lateral and superior right cerebellar hemisphere (thick arrows). Regression of lesions with mild atrophy is compatible with natural evolution of hemicerebellitis in opposition of progressive lesions (e.g. tumors).