Effects of systemic corticosteroid treatment on pseudotumoral hemicerebellitis: a case report and literature review
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CASE REPORT
Effects of systemic corticosteroid treatment on pseudotumoral hemicerebellitis: a case report and literature review Amirti Vivekanandan 1
&
Brendan Santyr 1 & Adrianna Ranger 1,2
Received: 20 July 2020 / Accepted: 10 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Pseudotumoral hemicerebellitis is an acute, unilateral inflammation of the cerebellum that typically affects the pediatric population. The purpose of this paper is to review cases of pseudotumoral hemicerebellitis in the literature and evaluate if treatment with systemic corticosteroids reduces length of time to symptomatic recovery. Methods We present a case report of a 12-year-old male with pseudotumoral hemicerebellitis and unilateral cerebellar dysfunction. Additionally, we review the thirty-five reported cases of pseudotumoral hemicerebellitis with respect to length of time to symptomatic recovery with or without systemic corticosteroid treatment. Results Thirty cases reported length of time to symptomatic recovery. Including our case, the mean time to recovery for those treated with systemic corticosteroids (n = 20) was 48.05 days (SE = 16.3). The mean time to recovery for those treated without (n = 10) was 86.7 days (SE = 29.3). Conclusions Treatment with systemic corticosteroids was associated with a faster time to symptomatic recovery compared to without. Regardless of etiology, reducing inflammation and mass effect involved in pseudotumoral hemicerebellitis may be integral to a more rapid return to neurological baseline. Keywords Pseudotumoral hemicerebellitis . Corticosteroids . MRI . Pediatric
Introduction Rare diseases in children that mimic more common conditions present a diagnostic challenge to physicians, potentially leading to unnecessary testing and interventions. This can subject patients and their families to potentially invasive procedures, while burdening health systems with an inefficient use of resources. Unilateral inflammation of the cerebellum presenting with symptoms mimicking those of a space occupying lesion is a rare, acute process termed pseudotumoral hemicerebellitis. The etiology remains to be elucidated; however, some cases have been attributed to post-infectious inflammation [1]. The presentation of pseudotumoral hemicerebellitis can vary but
* Amirti Vivekanandan [email protected] 1
Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
2
Paediatric Neurosurgery, Children’s Hospital, London Health Sciences Centre, Victoria Campus, London, Ontario, Canada
typically affects the pediatric population, though there has been one case described in a 73-year-old man [2]. Frequently, it is seen with either ipsilateral cerebellar signs, symptoms of increased intracranial pressure (ICP), or both [1, 3, 4]. Although the pathophysiology is not clear, histopathology from cases that underwent biopsy provides some clues to the mechanism of the disease. A cerebellar leptomeningeal lymphoplasmocytic and mononuclear infiltrate tends to be iden
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