Elsevier

Pediatric Neurology

Volume 46, Issue 1, January 2012, Pages 48-50
Pediatric Neurology

Case Report
Rotavirus Cerebellitis: New Aspects to an Old Foe?

https://doi.org/10.1016/j.pediatrneurol.2011.10.002Get rights and content

Abstract

Rotavirus infection is a significant cause of childhood morbidity and mortality worldwide. Although infection primarily causes gastroenteritis and dehydration, systemic signs and neurologic manifestations in rotavirus infection are widely recognized. The pathophysiologic origins of neurologic signs in rotavirus infection remain incompletely understood. We present a 4-year-old girl with clinical features of severe cerebellitis in association with abnormalities detected on magnetic resonance imaging. Rotavirus nucleic acid was demonstrated in both serum and cerebrospinal fluid. Severe neurologic sequelae remain after 2 years of follow-up. This report adds further evidence supporting a direct role for rotavirus in neurologic illness.

Introduction

Rotavirus is recognized as a significant cause of severe gastroenteritis in children under age 5 years, and is estimated to result in two million hospitalizations and 527,000 deaths per year worldwide [1]. Rotavirus is increasingly recognized as a routine cause of systemic infection [2].

We present a 4-year-old girl with encephalitis and features of cerebellar inflammation on magnetic resonance imaging, in whom rotavirus RNA was detected in blood and cerebrospinal fluid.

Section snippets

Case Report

A previously healthy 4-year-old girl presented after 3 days of diarrhea and vomiting, and was admitted for intravenous rehydration. Rotavirus antigen was detected by enzyme immunoassay in a sample of her stool. During the subsequent 2 days, her diarrhea and vomiting improved, but she became agitated and demonstrated progressive deterioration in her conscious state. She became atonic and mute, and developed nonpurposeful eye and limb movements.

Computed axial tomography of the patient’s brain on

Discussion

The demonstration of rotavirus RNA in serum and cerebrospinal fluid, an abnormal magnetic resonance signal in the cerebellum, and neutrophil pleocytosis in cerebrospinal fluid, in the absence of other bacterial or viral pathogens, argue strongly for a causal role of rotavirus in this girl’s meningoencephalitis. This case also provides additional insights into the spectrum of rotavirus-associated neurologic illness.

Although early reviews focused almost exclusively on the tropism of rotavirus for

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