Acute cerebellitis in children: an eleven year retrospective multicentric study in Italy
Abstract Background Acute cerebellitis (AC) and acute cerebellar ataxia (ACA) are the principal causes of acute cerebellar dysfunction in childhood. Nevertheless. there is no accepted consensus regarding the best management of children with AC/ACA: the aim of the study is both to assess clinical, ne...
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| Language: | English |
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BMC
2017-06-01
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| Series: | Italian Journal of Pediatrics |
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| Online Access: | http://link.springer.com/article/10.1186/s13052-017-0370-z |
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| author | Laura Lancella Susanna Esposito Maria Luisa Galli Elena Bozzola Valeria Labalestra Elena Boccuzzi Andrzej Krzysztofiak Laura Cursi Guido Castelli Gattinara Nadia Mirante Danilo Buonsenso Claudia Tagliabue Luca Castellazzi Carlotta Montagnani Chiara Tersigni Piero Valentini Michele Capozza Davide Pata Maria Di Gangi Piera Dones Silvia Garazzino Luca Baroero Alberto Verrotti Maria Luisa Melzi Michele Sacco Michele Germano Filippo Greco Elena Uga Giovanni Crichiutti Alberto Villani |
| author_facet | Laura Lancella Susanna Esposito Maria Luisa Galli Elena Bozzola Valeria Labalestra Elena Boccuzzi Andrzej Krzysztofiak Laura Cursi Guido Castelli Gattinara Nadia Mirante Danilo Buonsenso Claudia Tagliabue Luca Castellazzi Carlotta Montagnani Chiara Tersigni Piero Valentini Michele Capozza Davide Pata Maria Di Gangi Piera Dones Silvia Garazzino Luca Baroero Alberto Verrotti Maria Luisa Melzi Michele Sacco Michele Germano Filippo Greco Elena Uga Giovanni Crichiutti Alberto Villani |
| author_sort | Laura Lancella |
| collection | DOAJ |
| description | Abstract Background Acute cerebellitis (AC) and acute cerebellar ataxia (ACA) are the principal causes of acute cerebellar dysfunction in childhood. Nevertheless. there is no accepted consensus regarding the best management of children with AC/ACA: the aim of the study is both to assess clinical, neuroimaging and electrophysiologic features of children with AC/ACA and to evaluate the correlation between clinical parameters, therapy and outcome. Methods A multicentric retrospective study was conducted on children ≤ 18 years old admitted to 12 Italian paediatric hospitals for AC/ACA from 01/01/2003 to 31/12/2013. A score based on both cerebellar and extracerebellar signs/symptoms was computed for each patient. One point was given for each sign/symptom reported. Severity was divided in three classes: low, moderate, severe. Results A total of 124 children were included in the study. Of these, 118 children received a final diagnosis of ACA and 6 of AC. The most characteristic finding of AC/ACA was a broad-based gait disturbance. Other common symptoms included balance disturbances, slurred speech, vomiting, headache and fever. Neurological sequelae were reported in 6 cases (5%) There was no correlation among symptoms, cerebrospinal fluid findings, clinical outcome. There was no correlation between clinical manifestations and clinical score on admission and length of hospital stay, sex, age and EEG findings with sequelae (P > 0.05). Children with pathological magnetic resonance imaging (MRI) or computed tomography (CT) had a higher probability of having clinical sequelae. Treatment was decided independently case by case. Patients with a higher clinical score on admission had a higher probability of receiving intravenous steroids. Conclusions We confirmed the literature data about the benign course of AC/ACA in most cases but we also highlighted a considerable rate of patients with neurological sequelae (5%). Pathological MRI or CT findings at admission correlate to neurological sequelae. These findings suggest the indication to perform an instrumental evaluation in all patients with AC/ACA at admission to identify those at higher risk of neurological outcome. These patients may benefit from a more aggressive therapeutic strategy and should have a closer follow-up. Randomized controlled trials are needed to confirm these observations. The ultimate goal of these studies could be to develop a standardized protocol on AC/ACA. The MRI/CT data, associated with the clinical manifestations, may allow us to define the class risk of patients for a neurological outcome. |
| first_indexed | 2024-12-14T20:48:04Z |
| format | Article |
| id | doaj.art-9d9aadfa565b46d7a8ee936dd4acfb5e |
| institution | Directory Open Access Journal |
| issn | 1824-7288 |
| language | English |
| last_indexed | 2024-12-14T20:48:04Z |
| publishDate | 2017-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Italian Journal of Pediatrics |
| spelling | doaj.art-9d9aadfa565b46d7a8ee936dd4acfb5e2022-12-21T22:47:57ZengBMCItalian Journal of Pediatrics1824-72882017-06-0143111010.1186/s13052-017-0370-zAcute cerebellitis in children: an eleven year retrospective multicentric study in ItalyLaura Lancella0Susanna Esposito1Maria Luisa Galli2Elena Bozzola3Valeria Labalestra4Elena Boccuzzi5Andrzej Krzysztofiak6Laura Cursi7Guido Castelli Gattinara8Nadia Mirante9Danilo Buonsenso10Claudia Tagliabue11Luca Castellazzi12Carlotta Montagnani13Chiara Tersigni14Piero Valentini15Michele Capozza16Davide Pata17Maria Di Gangi18Piera Dones19Silvia Garazzino20Luca Baroero21Alberto Verrotti22Maria Luisa Melzi23Michele Sacco24Michele Germano25Filippo Greco26Elena Uga27Giovanni Crichiutti28Alberto Villani29Pediatric and Infectious Diseases Unit, IRCCS Bambino Gesù Children HospitalPediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Universita degli Studi di Milano, IRCCS Ca’ Granda Ospedale Foundation, Policlinico MaggioreDepartment of Paediatrics, Pediatric Infectious Disease Unit, University of Florence, Meyer Children’s HospitalPediatric and Infectious Diseases Unit, IRCCS Bambino Gesù Children HospitalPediatric and Infectious Diseases Unit, IRCCS Bambino Gesù Children HospitalPediatric and Infectious Diseases Unit, IRCCS Bambino Gesù Children HospitalPediatric and Infectious Diseases Unit, IRCCS Bambino Gesù Children HospitalPediatric and Infectious Diseases Unit, IRCCS Bambino Gesù Children HospitalPediatric and Infectious Diseases Unit, IRCCS Bambino Gesù Children HospitalPediatric and Infectious Diseases Unit, IRCCS Bambino Gesù Children HospitalPediatric and Infectious Diseases Unit, IRCCS Bambino Gesù Children HospitalPediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Universita degli Studi di Milano, IRCCS Ca’ Granda Ospedale Foundation, Policlinico MaggiorePediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Universita degli Studi di Milano, IRCCS Ca’ Granda Ospedale Foundation, Policlinico MaggioreDepartment of Paediatrics, Pediatric Infectious Disease Unit, University of Florence, Meyer Children’s HospitalDepartment of Paediatrics, Pediatric Infectious Disease Unit, University of Florence, Meyer Children’s HospitalPediatric Infectious Diseases Unit, Department of Pediatrics, Catholic University A, Gemelli HospitalPediatric Infectious Diseases Unit, Department of Pediatrics, Catholic University A, Gemelli HospitalPediatric Infectious Diseases Unit, Department of Pediatrics, Catholic University A, Gemelli HospitalInfectious Disease Section, Palermo-Civico Hospital, Azienda di Rilievo Nazionale ad Alta Specializzazione (ARNAS)Infectious Disease Section, Palermo-Civico Hospital, Azienda di Rilievo Nazionale ad Alta Specializzazione (ARNAS)Department of Paediatrics, University of Turin, Regina Margherita Children’s HospitalDepartment of Paediatrics, University of Turin, Regina Margherita Children’s HospitalDepartment of Pediatrics, University of L’AquilaDepartment of Pediatrics, Bicocca, Fondazione MBBM, San Gerardo HospitalMaternal and Pediatric Department, IRCCS CSS HospitalMaternal and Pediatric Department, IRCCS CSS HospitalUnit of Clinical Pediatrics, Vittorio Emanuele Hospital, University of CataniaPediatric Unit, ASL VercelliPediatric Unit, University-Hospital of UdinePediatric and Infectious Diseases Unit, IRCCS Bambino Gesù Children HospitalAbstract Background Acute cerebellitis (AC) and acute cerebellar ataxia (ACA) are the principal causes of acute cerebellar dysfunction in childhood. Nevertheless. there is no accepted consensus regarding the best management of children with AC/ACA: the aim of the study is both to assess clinical, neuroimaging and electrophysiologic features of children with AC/ACA and to evaluate the correlation between clinical parameters, therapy and outcome. Methods A multicentric retrospective study was conducted on children ≤ 18 years old admitted to 12 Italian paediatric hospitals for AC/ACA from 01/01/2003 to 31/12/2013. A score based on both cerebellar and extracerebellar signs/symptoms was computed for each patient. One point was given for each sign/symptom reported. Severity was divided in three classes: low, moderate, severe. Results A total of 124 children were included in the study. Of these, 118 children received a final diagnosis of ACA and 6 of AC. The most characteristic finding of AC/ACA was a broad-based gait disturbance. Other common symptoms included balance disturbances, slurred speech, vomiting, headache and fever. Neurological sequelae were reported in 6 cases (5%) There was no correlation among symptoms, cerebrospinal fluid findings, clinical outcome. There was no correlation between clinical manifestations and clinical score on admission and length of hospital stay, sex, age and EEG findings with sequelae (P > 0.05). Children with pathological magnetic resonance imaging (MRI) or computed tomography (CT) had a higher probability of having clinical sequelae. Treatment was decided independently case by case. Patients with a higher clinical score on admission had a higher probability of receiving intravenous steroids. Conclusions We confirmed the literature data about the benign course of AC/ACA in most cases but we also highlighted a considerable rate of patients with neurological sequelae (5%). Pathological MRI or CT findings at admission correlate to neurological sequelae. These findings suggest the indication to perform an instrumental evaluation in all patients with AC/ACA at admission to identify those at higher risk of neurological outcome. These patients may benefit from a more aggressive therapeutic strategy and should have a closer follow-up. Randomized controlled trials are needed to confirm these observations. The ultimate goal of these studies could be to develop a standardized protocol on AC/ACA. The MRI/CT data, associated with the clinical manifestations, may allow us to define the class risk of patients for a neurological outcome.http://link.springer.com/article/10.1186/s13052-017-0370-zCerebellitisChildrenOutcomeTherapy |
| spellingShingle | Laura Lancella Susanna Esposito Maria Luisa Galli Elena Bozzola Valeria Labalestra Elena Boccuzzi Andrzej Krzysztofiak Laura Cursi Guido Castelli Gattinara Nadia Mirante Danilo Buonsenso Claudia Tagliabue Luca Castellazzi Carlotta Montagnani Chiara Tersigni Piero Valentini Michele Capozza Davide Pata Maria Di Gangi Piera Dones Silvia Garazzino Luca Baroero Alberto Verrotti Maria Luisa Melzi Michele Sacco Michele Germano Filippo Greco Elena Uga Giovanni Crichiutti Alberto Villani Acute cerebellitis in children: an eleven year retrospective multicentric study in Italy Italian Journal of Pediatrics Cerebellitis Children Outcome Therapy |
| title | Acute cerebellitis in children: an eleven year retrospective multicentric study in Italy |
| title_full | Acute cerebellitis in children: an eleven year retrospective multicentric study in Italy |
| title_fullStr | Acute cerebellitis in children: an eleven year retrospective multicentric study in Italy |
| title_full_unstemmed | Acute cerebellitis in children: an eleven year retrospective multicentric study in Italy |
| title_short | Acute cerebellitis in children: an eleven year retrospective multicentric study in Italy |
| title_sort | acute cerebellitis in children an eleven year retrospective multicentric study in italy |
| topic | Cerebellitis Children Outcome Therapy |
| url | http://link.springer.com/article/10.1186/s13052-017-0370-z |
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