Acute Cerebellitis and Obstructive Hydrocephalus: An Unseen Neurological Complication After Surgical Repair for Tetralogy of Fallot

TL;DR

A rare and aggressive neurological complication, acute cerebellitis with obstructive hydrocephalus, occurred after Tetralogy of Fallot surgery in a child, leading to a fatal outcome despite treatment.

Contribution

This paper reports a rare case of acute cerebellitis with obstructive hydrocephalus following Tetralogy of Fallot surgery in a pediatric patient.

Findings

Neurological symptoms rapidly progressed post-surgery, leading to drowsiness and intermittent responsiveness.

Computed tomography scans initially showed no abnormalities but later revealed cerebellitis and hydrocephalus.

Treatment with steroids, antibiotics, and cerebrospinal fluid drainage failed to halt the fatal progression.

Abstract

Acute cerebellitis with obstructive hydrocephalus post-Tetralogy of Fallot surgery is extremely rare but can present aggressively in pediatric cases. Early diagnosis is critical for prompt medical and surgical intervention. We report a fatal case in a 7-year-old boy post-surgery, where neurological symptoms rapidly progressed, leading to drowsiness and intermittent response to commands. Despite initial computed tomography scans showing no abnormality, subsequent scans revealed cerebellitis and hydrocephalus. Treatment with steroids, antibiotics, and cerebrospinal fluid drainage was unsuccessful, and the condition’s etiology remained unclear despite negative serological tests and cultures. This highlights the challenge of diagnosing and treating acute cerebellitis, especially when no specific cause is found and when deterioration is swift. The role of opioids in pediatric patients and their potential association with neurosurgical complications is also discussed, prompting further inquiry into postoperative symptoms and opioid-related risks in susceptible individuals.

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