Cerebellar hemorrhage as the primary clinical manifestation of hyperacute disseminated encephalomyelitis: a case report
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LETTER TO THE EDITOR
Cerebellar hemorrhage as the primary clinical manifestation of hyperacute disseminated encephalomyelitis: a case report Shaoyang Sun1 · Jing Wang1 · Min Liu1 · Tao Liu1 · Yanqiang Wang2 Received: 6 October 2018 / Accepted: 5 January 2019 © Belgian Neurological Society 2019
Introduction Acute disseminated encephalomyelitis (ADEM) is an acute inflammatory demyelinating encephalopathy with extensive involvement of the white matter. The clinical manifestations include headache, epileptic seizures, ataxia, quadriplegia, mental symptoms, altered consciousness and other multifocal neurological dysfunctions. Acute hemorrhagic leukoencephalitis (AHLE) is a relatively rare inflammatory demyelinating disease of the central nervous system that is considered a hyperacute type of ADEM [1]. There are no clinical reports of hyperacute ADEM in which cerebellar symptoms are the primary manifestation. We report a case of hyperacute ADEM with cerebellar hemorrhage as the primary manifestation.
Case report A 32 year old Chinese woman underwent surgical treatment for right congenital blepharoptosis. The patient developed dizziness, vertigo and nausea that improved in the supine position by post-operative day (POD) 7. These symptoms gradually worsened and were accompanied with frequent vomiting. On POD 8 the patient was sent to the emergency department of our hospital. An emergency head CT showed acute hemorrhage in the left cerebellar hemisphere and cerebellar vermis (Fig. 1). The patient was admitted on POD 13 with cerebellar vermis hemorrhage as the chief finding. Shaoyang Sun and Wang Jing contributed equally to this work. * Yanqiang Wang [email protected] 1
Department of Neurology, Affiliated Hospital of Qingdao University, Qingdao, China
Department of Neurology, The Affiliated Hospital of Wei Fang Medical University, Weifang, China
2
Neurologic examination on admission found the patient to be alert, cooperative and conversant. The patient had restriction of upward gaze, slight restriction of abduction of the left eye, horizontal nystagmus, a surgical scar of the right eyelid which prevented closure, and an enlarged palpebral fissure. All cranial nerves were intact. The patient had grade 4 + muscle strength, normal muscle tone, cerebellar ataxia (+), no pathological reflexes, and no meningeal irritation. Admission blood tests revealed leukocytosis consisting mainly of neutrophils, a C-reactive protein (CRP) of 37.9 mg/L (normal value: ≤ 10 mg/L), and an erythrocyte sedimentation rate of 63 mm/h (normal value: ≤ 20 mm/h). blood cultures were negative, No pathogens were identified in cerebrospinal fluid (CSF) by smear or culture. CSF pressure, routine and biochemical test results are shown in Table 1, No CSF-specific oligoclonal bands were detected. Gram staining, acid-fast staining, lactic acid and cryptococcal antigen test results were negative. CSF did not grow any bacteria, fungus, or acid-fast bacillus at culture. CSF analyses did not reveal evidence for these viruses (HSV, VZV, EBV, and CM
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