Presentation
Fever, headache, vomiting and decreased level of consciousness.
Patient Data
Diffuse swelling of both cerebellar hemispheres, which appear hyperintense on both T2W and FLAIR sequences, and show restricted diffusion on DW/ADC, leptomeningeal enhancement on T1W post-contrast.
It causes regional mass effect in the form of compressing both middle cerebellar peduncles, effacement both cerebellopontine angles, foramen magnum and indenting the IV ventricle, subsequently causing mild supratentorial hydrocephalus.
There is marked decrease in edematous changes of cerebellar hemispheres, no restricted diffusion except for a small area in right paramidline of superior cerebellar hemisphere posteriorly, likely small residual inflammation.
Prominent folia in both cerebellar hemispheres inferiorly.
No significant hydrocephalus.
Case Discussion
Bilateral hemispheric cerebellar swelling with cortical and white matter T2W hyperintensities, preserved striations, leptomeningeal enhancement, suggestive inflammatory process of cerebellum, acute cerebellitis.
Follow up after one month revealed marked progression of cerebellar MRI signal changes after treatment.
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