Are there any differences between adult-onset cerebellitis and childhood cerebellitis?

TL;DR

This study compares adult-onset cerebellitis with childhood cases, finding that adults experience more severe symptoms and outcomes.

Contribution

The paper presents the largest case series of adult-onset acute cerebellitis, highlighting distinct clinical features and outcomes compared to pediatric cases.

Findings

Adult-onset cerebellitis shows distinct clinical, laboratory, and imaging features compared to childhood cases.

Severe outcomes are common in adult-onset cerebellitis, with 56% experiencing severe sequelae and 31% mortality.

MRI findings in adults show bilateral cerebellar involvement, often with cortical lesions and occasional hemorrhage.

Abstract

Acute cerebellitis (AC), a rare inflammatory disorder of the cerebellum, is primarily associated with infectious, post-infectious, and autoimmune mechanisms. It predominantly affects children and typically follows a benign and self-limited course. This study, the largest case series to date focusing exclusively on adult-onset AC, reveals distinct clinical, laboratory, and imaging characteristics compared to the pediatric AC literature. We included 16 patients (mean age of 39.5 years) who met the clinico-radiological features of AC. The causes of AC in this study were varied, encompassing paraneoplastic, post-infectious, infectious, anti-GAD-related, and hemophagocytic lymphohistiocytosis etiologies. The most common symptoms were altered consciousness, dysarthria, ataxia, vomiting, fever, headache and seizures. All cases showed bilateral cerebellar involvement on MRI, predominantly affecting the cerebellar cortex. Hemorrhage within cerebellar lesions was observed in three patients. Outcomes were often severe, with 56% of patients experiencing severe sequelae and 31% mortality. This study highlights the distinct characteristics and potential for severe outcomes in adult AC, emphasizing the need for a comprehensive diagnostic approach.

The online version contains supplementary material available at 10.1007/s10072-025-08127-5.

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