Acute cerebellitis in a 10-year-old male: Diagnostic and management challenges in a resource-limited setting

Acute cerebellitis (AC) is an inflammatory disease of the cerebellum following viral, bacterial infections, or autoimmune-mediated processes. Diagnosis and management of its complications, such as hydrocephalus, are particularly challenging in resource-limited settings. This report highlights these challenges and the successful outcome achieved with conservative medical management, averting the need for surgical intervention for AC-associated obstructive hydrocephalus. A 10-year-old male was referred to our facility with a complaint of persistent headache for 10 days associated with cerebellar signs (wide-based gait, dysarthria, and dysmetria) and projectile vomiting. Brain MRI showed features of AC with moderate hydrocephalus. The patient was managed conservatively with intravenous ceftriaxone, dexamethasone, and acetazolamide. This led to complete clinical recovery and averted the need for surgical intervention. A follow-up MRI one-month post-treatment confirmed complete radiological resolution of both the cerebellitis and hydrocephalus. This case underscores the importance of a high index of suspicion for AC in resource-limited settings when a child presents with headache and neurological signs. It demonstrates that medical management with steroids and acetazolamide can successfully resolve AC-associated obstructive hydrocephalus in select patients. This approach offers a viable strategy to avoid neurosurgical intervention in environments where resources are constrained.