Cerebellar Infarction in a 9 Year Old Child Presenting with Fever and Ataxia: A Case Report

• Published in: Iranian journal of child neurology Vol. 13; no. 1; pp. 107 - 114
• Main Authors: Vafaeeshahi, Mohammad, Azizishalbaf, Nazanin, Tahernia, Leila
• Format: Journal Article
• Language: English
• Published: Iran Iranian Child Neurology Society 2019; Shahid Beheshti University of Medical Sciences
• Subjects: Ataxia; Case Report; Case reports; Cerebellum; Cerebral infarction; Children; Computed tomography; Emergency medical care; Fever; Headache; Hemispheric laterality; Ischemia; Magnetic resonance imaging; Medical imaging; Neuroimaging; NMR; Nuclear magnetic resonance; Pediatrics; Stroke; Surgery; Tomography; Trauma; Vasoconstriction; Vertebrae; Vomiting; Ataxia; Cerebellar; Case report; Infarction; MRI
• DOI: 10.22037/ijcn.v13i1.17170
• ISSN: 1735-4668

Cerebellar acute ischemic stroke (AIS) can be a complication of minor head trauma, vertebral artery dissection, vasospasm or systemic hypoperfusion. CT scan usually is negative few hours after acute infarction. Magnetic resonance imaging (MRI) is superior to CT scan for posterior fossa lesions and also in acute phase of cerebellar stroke especially in children. Here we report a 9 yr old girl referred to the Pediatric Emergency Room, Moosavi Hospital, Zanjan, Iran in January 2017 presenting with sudden onset of headache and recurrent vomiting, ataxia, and history of 3 consecutive days of fever and malaise. In the report of MRI, there were abnormal low T1 and high T2 signal intensity in left cerebellar hemisphere involving superior and middle cerebellar peduncles. After 4 days of admission, the patient became drowsy, symptoms progressed and transferred to the pediatric intensive care unit (PICU). The patient underwent hemispherectomy surgery of the left cerebellar hemisphere because of acute obstructive hydrocephaly. After 5 months of occupational therapy, the force of her extremities was normal and the ataxia completely disappeared. Childhood acute ischemic stroke although rare can happen with cerebellar involvement. Because in our patient the first brain CT scan was nearly normal and a false negative rate for initial computed tomography (CT) scanning of 60%-80% also contributes to missed and delayed diagnosis of childhood AIS, for every child presenting with acute ataxia without identified cause in addition to CT scan, MRI also being ordered and from the beginning besides other causes, stroke be contemplated as a cause of ataxia.