Department of Pediatrics, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan.
AJNR Am J Neuroradiol. 2010 Oct;31(9):1591-5. doi: 10.3174/ajnr.A2131. Epub 2010 May 27.
Neurological manifestations, such as benign convulsions and encephalitis/encephalopathy have been reported in patients with rotavirus gastroenteritis. However, cerebellitis has not attracted much attention. The purpose of this study was to identify and report the clinical and radiologic features of rotavirus cerebellitis.
Records of patients with rotavirus gastroenteritis exhibiting cerebellar lesions on MR imaging were collected from multiple centers in Japan. Their clinical, laboratory, and radiologic data were reviewed retrospectively.
A diagnosis of acute cerebellitis concurrent with encephalitis was made for 11 of 13 patients identified. Two patients who were diagnosed as having injury due to hypovolemic shock were excluded from the study. All 11 patients with acute cerebellitis had disorders of consciousness with onset on days 2 to 4, followed by mutism in 10 patients. Other cerebellar symptoms included dysarthria following the mutism, hypotonia, ataxia, tremor, nystagmus, and dysmetria. MR imaging lesions in the vermis or cerebellar cortex were seen at some point (day 5 to 1 year) in 10 patients. A reversible splenial lesion (3 isolated and 3 with concurrent cerebellar lesions) was found in 6 patients scanned between days 4 and 6. Transient lesions in the cerebellar white matter/nuclei manifesting reduced diffusion were seen in 6 patients during days 5 through 7. The final MR imaging performed after 1 month showed cerebellar atrophy in 10 patients.
The 11 patients with rotavirus cerebellitis exhibited nearly identical clinical and MR imaging features. Involvement of the cerebellar white matter/nuclei may be associated with the mutism. An isolated splenial lesion with homogeneously reduced diffusion is not always a benign sign indicative of complete clinical and radiologic recovery in patients with rotavirus gastroenteritis.
轮状病毒胃肠炎患者可出现良性惊厥和脑炎/脑病等神经表现，但小脑炎尚未引起太多关注。本研究旨在确定和报告轮状病毒小脑炎的临床和影像学特征。
从日本多个中心收集轮状病毒胃肠炎患者磁共振成像（MRI）显示小脑病变的病例。回顾性分析其临床、实验室和影像学资料。
确诊 13 例患者中的 11 例为急性小脑炎伴脑炎。排除了 2 例因低血容量性休克导致损伤的患者。所有 11 例急性小脑炎患者均存在意识障碍，起病于第 2-4 天，随后 10 例出现缄默症。其他小脑症状包括缄默后言语障碍、肌张力低下、共济失调、震颤、眼球震颤和辨距不良。10 例患者在某个时间点（第 5-1 年）出现蚓部或小脑皮质的 MRI 病变。6 例患者在第 4-6 天扫描时发现 3 例孤立性和 3 例伴发小脑病变的可逆性胼胝体病变。6 例患者在第 5-7 天出现小脑白质/核内短暂性病变，弥散受限。1 个月后进行的最终 MRI 显示 10 例患者出现小脑萎缩。
11 例轮状病毒小脑炎患者的临床表现和 MRI 特征几乎相同。小脑白质/核受累可能与缄默症有关。孤立性胼胝体病变伴均匀弥散受限并不总是轮状病毒胃肠炎患者完全临床和影像学恢复的良性征象。
