A Case Report of Cerebellitis with Cranial Section Nerve Involvement in a Patient with Scrub Typhus Encephalitis

Meningoencephalitis refers to inflammation involving both the meninges and brain parenchyma and represents a critical neurological emergency. The clinical picture can be diverse, often including altered sensorium, fever, seizures, and focal neurological deficits. The presence of both cerebellar and cranial nerve involvement leads to a complex presentation, causing the diagnosis to be more difficult due to the overlap with other neurological disorders. This case study aims to describe an uncommon presentation of scrub typhus-related meningoencephalitis with bilateral sixth nerve palsy and pan-cerebellar clinical presentation in a young adult. A 20- year-old female presented with high-grade fever, severe headache, vomiting, diplopia, and unsteady gait. Systemic examination revealed signs of cerebellar dysfunction, including ataxia and dysdiadochokinesia, along with involvement of the 6th cranial nerve with bilateral lateral rectus palsy and papilloedema. Laboratory workup included haematological and biochemical investigations, Cerebrospinal Fluid (CSF) analysis. Specific serological testing for tropical infections was also performed, which showed scrub typhus IgM positivity. Magnetic Resonance Imaging (MRI) showed meningeal enhancement involving the bilateral tentorium cerebelli. The patient received intravenous antibiotics, cephalosporins and tetracyclines, corticosteroids and anti-oedema measures with appropriate therapy, and neurological deficits gradually resolved over the next 10 days. In endemic areas, scrub typhus should be considered in the differential diagnosis of meningoencephalitis, particularly when accompanied by atypical features like cerebellar signs and cranial nerve palsies. Early detection and appropriate management often lead to the resolution of neurological symptoms and prevent long-term complications.