Skip to main content

Advertisement

SpringerLink
Log in

Magnetic resonance imaging findings in patients presenting with (sub)acute cerebellar ataxia

  • Diagnostic Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Introduction

Acute or subacute cerebellar inflammation is mainly caused by postinfectious, toxic, neoplastic, vascular, or idiopathic processes and can result in cerebellar ataxia. Previous magnetic resonance (MR) studies in single patients who developed acute or subacute ataxia showed varying imaging features.

Methods

Eighteen patients presenting with acute and subacute onset of ataxia were included in this study. Cases of chronic-progressive/hereditary and noncerebellar causes (ischemia, multiple sclerosis lesions, metastasis, bleedings) were excluded. MR imaging findings were then matched with the clinical history of the patient.

Results

An underlying etiology for ataxic symptoms were found in 14/18 patients (postinfectious/infectious, paraneoplastic, autoimmune, drug-induced). In two of five patients without MR imaging findings and three of eight patients with minimal imaging features (cerebellar atrophy, slight signal alterations, and small areas of restricted diffusion), adverse clinical outcomes were documented. Of the five patients with prominent MR findings (cerebellar swelling, contrast enhancement, or broad signal abnormalities), two were lost to follow-up and two showed long-term sequelae.

Conclusion

No correlation was found between the presence of initial MRI findings in subacute or acute ataxia patients and their long-term clinical outcome. MR imaging was more flagrantly positive in cases due to encephalitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Martinez-Gonzalez MJ, Martinez-Gonzalez S, Garcia-Ribes A, Mintegi-Raso S, Benito-Fernandez J, Prats-Vinas JM (2006) Acute onset ataxia in infancy: its aetiology, treatment and follow-up. Rev Neurol 42(6):321–324

    CAS  PubMed  Google Scholar 

  2. Gieron-Korthals MA, Westberry KR, Emmanuel PJ (1994) Acute childhood ataxia: 10-year experience. J Child Neurol 9(4):381–384

    Article  CAS  PubMed  Google Scholar 

  3. Moses H, Nagel MA, Gilden DH (2006) Acute cerebellar ataxia in a 41 year old woman. Lancet Neurol 5(11):984–988. doi:10.1016/S1474-4422(06)70601-9

    Article  PubMed  Google Scholar 

  4. Cho TA, Schmahmann JD, Cunnane ME (2013) Case records of the Massachusetts General Hospital. Case 30-2013. A 19-year-old man with otalgia, slurred speech, and ataxia. N Engl J Med 369(13):1253–1261. doi:10.1056/NEJMcpc1214218

    Article  CAS  PubMed  Google Scholar 

  5. Whelan HT, Verma S, Guo Y, Thabet F, Bozarth X, Nwosu M, Katyayan A, Parachuri V, Spangler K, Ruggeri BE, Srivatsal S, Zhang G, Ashwal S (2013) Evaluation of the child with acute ataxia: a systematic review. Pediatr Neurol 49(1):15–24. doi:10.1016/j.pediatrneurol.2012.12.005

    Article  PubMed  Google Scholar 

  6. Desai J, Mitchell WG (2012) Acute cerebellar ataxia, acute cerebellitis, and opsoclonus-myoclonus syndrome. J Child Neurol 27(11):1482–1488. doi:10.1177/0883073812450318

    Article  PubMed  Google Scholar 

  7. Liu Y, Nuutinen J, Laakso MP, Karonen JO, Kononen M, Vanninen E, Kuikka JT, Vanninen RL (2010) Cerebellar apparent diffusion coefficient changes in patients with supratentorial ischemic stroke. Acta Neurol Scand 122(5):316–322. doi:10.1111/j.1600-0404.2009.01289.x

    Article  CAS  PubMed  Google Scholar 

  8. Reiss KA, Bailey JR, Pham PA, Gallant JE (2010) Raltegravir-induced cerebellar ataxia. Aids 24(17):2757. doi:10.1097/QAD.0b013e32833fca42

    Article  PubMed  Google Scholar 

  9. De Bruecker Y, Claus F, Demaerel P, Ballaux F, Sciot R, Lagae L, Buyse G, Wilms G (2004) MRI findings in acute cerebellitis. Eur Radiol 14(8):1478–1483. doi:10.1007/s00330-004-2247-y

    Article  PubMed  Google Scholar 

  10. Carceller Lechon F, Duat Rodriguez A, Sirvent Cerda SI, Khabra K, de Prada I, Garcia-Penas JJ, Madero Lopez L (2013) Hemicerebellitis: report of three paediatric cases and review of the literature. Eur J Paediatr Neurol. doi:10.1016/j.ejpn.2013.12.004

    PubMed  Google Scholar 

  11. Hennes E, Zotter S, Dorninger L, Hartmann H, Hausler M, Huppke P, Jacobs J, Kraus V, Makowski C, Schlachter K, Ulmer H, van Baalen A, Koch J, Gotwald T, Rostasy K (2012) Long-term outcome of children with acute cerebellitis. Neuropediatrics 43(5):240–248. doi:10.1055/s-0032-1324732

    Article  CAS  PubMed  Google Scholar 

  12. Dogulu F, Onk A, Kaymaz M, Kardes O, Baykaner MK (2003) Acute cerebellitis with hydrocephalus. Neurology 60(10):1717

    Article  CAS  PubMed  Google Scholar 

  13. Lee KY, Lee YJ, Kim TH, Cheon DS, Nam SO (2014) Clinico-radiological spectrum in enterovirus 71 infection involving the central nervous system in children. J Clin Neurosci 21(3):416–420. doi:10.1016/j.jocn.2013.04.032

    Article  PubMed  Google Scholar 

  14. Takanashi J, Miyamoto T, Ando N, Kubota T, Oka M, Kato Z, Hamano S, Hirabayashi S, Kikuchi M, Barkovich AJ (2010) Clinical and radiological features of rotavirus cerebellitis. AJNR Am J Neuroradiol 31(9):1591–1595. doi:10.3174/ajnr.A2131

    Article  CAS  PubMed  Google Scholar 

  15. Kobayashi S, Negishi Y, Ando N, Ito T, Nakano M, Togari H, Wakuda M, Taniguchi K (2010) Two patients with acute rotavirus encephalitis associated with cerebellar signs and symptoms. Eur J Pediatr 169(10):1287–1291. doi:10.1007/s00431-010-1202-y

    Article  PubMed  Google Scholar 

  16. Hata A, Fujita M, Morishima T, Kumakura A, Hata D (2008) Acute cerebellar ataxia associated with primary human herpesvirus-6 infection: a report of two cases. J Paediatr Child Health 44(10):607–609. doi:10.1111/j.1440-1754.2008.01395.x

    Article  PubMed  Google Scholar 

  17. Burton JM, Kern RZ, Halliday W, Mikulis D, Brunton J, Fearon M, Pepperell C, Jaigobin C (2004) Neurological manifestations of West Nile virus infection. Can J Neurol Sci 31(2):185–193

    PubMed  Google Scholar 

  18. Fellgiebel A, Siessmeier T, Winterer G, Luddens H, Mann K, Schmidt LG, Bartenstein P (2004) Increased cerebellar PET glucose metabolism corresponds to ataxia in Wernicke-Korsakoff syndrome. Alcohol Alcohol 39(2):150–153

    Article  CAS  PubMed  Google Scholar 

  19. Nalini A, Kovoor JM, Dawn R, Kallur KG (2009) Marchiafava-Bignami disease: two cases with magnetic resonance imaging and positron emission tomography scan findings. Neurol India 57(5):644–648. doi:10.4103/0028-3886.57813

    Article  CAS  PubMed  Google Scholar 

  20. Appenzeller S, Cendes F, Costallat LT (2008) Cerebellar ataxia in systemic lupus erythematosus. Lupus 17(12):1122–1126. doi:10.1177/0961203308093071

    Article  CAS  PubMed  Google Scholar 

  21. Demir E, Aksoy A, Anlar B, Sonmez FM (2007) Atypical presentations of SSPE: a clinical study in four cases. Turk J Pediatr 49(3):295–300

    PubMed  Google Scholar 

  22. Niethammer M, Ford B (2007) Permanent lithium-induced cerebellar toxicity: three cases and review of literature. Mov Disord 22(4):570–573. doi:10.1002/mds.21318

    Article  PubMed  Google Scholar 

  23. Baizabal-Carvallo JF, Stocco A, Muscal E, Jankovic J (2013) The spectrum of movement disorders in children with anti-NMDA receptor encephalitis. Mov Disord 28(4):543–547. doi:10.1002/mds.25354

    Article  PubMed  Google Scholar 

  24. Sawaishi Y, Takada G (2002) Acute cerebellitis. Cerebellum 1(3):223–228. doi:10.1080/14734220260418457

    Article  PubMed  Google Scholar 

  25. Hoftberger R, Sabater L, Ortega A, Dalmau J, Graus F (2013) Patient with homer-3 antibodies and cerebellitis. JAMA Neurol 70(4):506–509. doi:10.1001/jamaneurol.2013.1955

    Article  PubMed Central  PubMed  Google Scholar 

  26. Marignier R, Chenevier F, Rogemond V, Sillevis Smitt P, Renoux C, Cavillon G, Androdias G, Vukusic S, Graus F, Honnorat J, Confavreux C (2010) Metabotropic glutamate receptor type 1 autoantibody-associated cerebellitis: a primary autoimmune disease? Arch Neurol 67(5):627–630. doi:10.1001/archneurol.2010.51

    PubMed  Google Scholar 

  27. Zuliani L, Sabater L, Saiz A, Baiges JJ, Giometto B, Graus F (2007) Homer 3 autoimmunity in subacute idiopathic cerebellar ataxia. Neurology 68(3):239–240. doi:10.1212/01.wnl.0000251308.79366.f9

    Article  CAS  PubMed  Google Scholar 

  28. Gruis KL, Moretti P, Gebarski SS, Mikol DD (2003) Cerebellitis in an adult with abnormal magnetic resonance imaging findings prior to the onset of ataxia. Arch Neurol 60(6):877–880. doi:10.1001/archneur.60.6.877

    Article  PubMed  Google Scholar 

  29. Donmez FY, Agildere AM, Tore HG, Ure S, Benli S (2008) Abnormal diffusion-weighted imaging findings in an adult patient with acute cerebellitis presenting with a normal magnetic resonance imaging. J Comput Assist Tomogr 32(1):156–158. doi:10.1097/RCT.0b013e3180653c8a

    Article  PubMed  Google Scholar 

  30. Sener RN (2002) Diffusion MRI in Rasmussen's encephalitis, herpes simplex encephalitis, and bacterial meningoencephalitis. Comput Med Imaging Graph 26(5):327–332

    Article  CAS  PubMed  Google Scholar 

  31. Guimaraes RP, D'Abreu A, Yasuda CL, Franca MC Jr, Silva BH, Cappabianco FA, Bergo FP, Lopes-Cendes IT, Cendes F (2013) A multimodal evaluation of microstructural white matter damage in spinocerebellar ataxia type 3. Mov Disord 28(8):1125–1132. doi:10.1002/mds.25451

    Article  PubMed  Google Scholar 

  32. Alcauter S, Barrios FA, Diaz R, Fernandez-Ruiz J (2011) Gray and white matter alterations in spinocerebellar ataxia type 7: an in vivo DTI and VBM study. NeuroImage 55(1):1–7. doi:10.1016/j.neuroimage.2010.12.014

    Article  CAS  PubMed  Google Scholar 

  33. Kitamura K, Nakayama K, Kosaka S, Yamada E, Shimada H, Miki T, Inoue Y (2008) Diffusion tensor imaging of the cortico-ponto-cerebellar pathway in patients with adult-onset ataxic neurodegenerative disease. Neuroradiology 50(4):285–292. doi:10.1007/s00234-007-0351-9

    Article  PubMed  Google Scholar 

Download references

Ethical standards and patient consent

We declare that all human and animal studies have been approved by the appropriate Ethics Committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that this manuscript does not contain clinical studies or patient data.

Conflict of interest

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Haus Ost 22, 20246, Hamburg, Germany

    Tanja Schneider & Einar Goebell

  2. Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Götz Thomalla

  3. Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Anna Piotrowski

  4. Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Neuroradiology, The Johns Hopkins Hospital School of Medicine, Baltimore, MD, USA

    Tanja Schneider & David Mark Yousem

Authors
  1. Tanja Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Götz Thomalla
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Einar Goebell
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anna Piotrowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David Mark Yousem
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tanja Schneider.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(PDF 143 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schneider, T., Thomalla, G., Goebell, E. et al. Magnetic resonance imaging findings in patients presenting with (sub)acute cerebellar ataxia. Neuroradiology 57, 551–559 (2015). https://doi.org/10.1007/s00234-015-1496-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-015-1496-6

Keywords

Search

Navigation