<%server.execute "isdev.asp"%> Unilateral cerebellar hypoplasia: A rare cause of childhood seizures Shaikh M, Khera P, Panda S - J Pediatr Neurosci
home : about us : ahead of print : current issue : archives search instructions : subscriptionLogin 
Users online: 567      Small font sizeDefault font sizeIncrease font size Print this page Email this page


 
  Table of Contents    
CASE REPORT
Year : 2019  |  Volume : 14  |  Issue : 4  |  Page : 236-237
 

Unilateral cerebellar hypoplasia: A rare cause of childhood seizures


1 Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
2 Department of Neurology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Date of Submission04-Jul-2018
Date of Decision04-Aug-2019
Date of Acceptance04-Sep-2019
Date of Web Publication05-Dec-2019

Correspondence Address:
Dr. Minhaj Shaikh
Senior Resident, Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan.
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpn.JPN_102_18

Rights and Permissions

 

   Abstract 

Cerebellar malformations are a rare group of disorders with clinical heterogeneity. The usual posterior fossa malformations comprise of the cystic lesions like Dandy-walker complex, enlarged cisterna magna or arachnoid cysts. The vermis is a commonly associated structure in both cystic and non-cystic posterior fossa malformations. The congenital malformations affecting the cerebellar parenchyma are however very rare. Magnetic resonance imaging (MRI) is an excellent modality to detect and accurately classify these malformations. We describe a case of 14 years old boy with unilateral cerebellar hypoplasia and recurrent seizures with emphasis on the MRI features of this rare entity.


Keywords: Cerebellar hypoplasia, Cerebellar dysplasia, Cerebellar malformation, Posterior fossa malformations


How to cite this article:
Shaikh M, Khera P, Panda S. Unilateral cerebellar hypoplasia: A rare cause of childhood seizures. J Pediatr Neurosci 2019;14:236-7

How to cite this URL:
Shaikh M, Khera P, Panda S. Unilateral cerebellar hypoplasia: A rare cause of childhood seizures. J Pediatr Neurosci [serial online] 2019 [cited 2020 Jan 22];14:236-7. Available from: http://www.pediatricneurosciences.com/text.asp?2019/14/4/236/272354





   Case Report Top


A 14-year-old boy, with normal birth and development, presented with multiple episodes of generalized tonic–clonic seizures for the previous three years. No preceding aura or any localizing features of the seizures was observed. No focal neurologic deficit was noted. No significant past medical history of head trauma, febrile seizures, or meningoencephalitis was reported. However, the patient had poor scholastic performance. No similar history of seizures was observed in his family. Electroencephalography showed generalized spike and wave discharges. Multiplanar and multisequence noncontrast magnetic resonance imaging (MRI) of the brain was performed using 3.0T MRI scanner (Discovery 750; GE Healthcare, Milwaukee, Wisconsin). A markedly reduced volume of the right cerebellar hemisphere was observed [Figure 1] and [Figure 2]. The residual right cerebellar hemisphere showed normal pattern of folia and gray white matter differentiation, suggestive of right cerebellar hypoplasia. The vermis was normal in bulk and in morphology. The right middle cerebellar peduncle showed reduced volume and normal signal intensity. The space created by hypoplastic right cerebellum was filled with cerebrospinal fluid (CSF). The fourth ventricle, midbrain, pons, and medulla were normal. The left cerebellar hemisphere was normal in bulk and signal intensity. The patient was started on sodium valproate and clobazam on which he was seizure free.
Figure 1: Axial T2WI of right cerebellar hypoplasia in craniocaudal sequence. A: There is marked hypoplasia of the right cerebellar hemisphere and replacement by CSF. The left cerebellar hemisphere is normal in bulk and signal intensity. B: At the level of internal auditory canals, the residual right cerebellum can be seen anteriorly. The normal bulk of vermis can also be seen. C: At the level of medulla, only a thin strip of residual right cerebellum is seen anteriorly. In all the images, the residual right cerebellum shows normal grey white differentiation and foliation. The left cerebellar hemisphere shows normal volume and morphology.

Click here to view
,
Figure 2: Coronal T1WI of right cerebellar hypoplasia in anteroposterior sequence. A: There is marked hypoplasia of the right cerebellar hemisphere and normal volume of left cerebellum. B: At a slightly more posterior plane, the thin strip of residual right cerebellum is seen superiorly. In both these T1 weighted images, the grey white matter differentiation and preserved folia in the residual right cerebellum can be better appreciated than T2 weighted images.

Click here to view



   Discussion Top


A rational classification of cerebellar malformation was proposed by Patel and Barkovich,[1] in 2002, with clear definitions and practical usability. Cerebellar malformations are classified into those with hypoplasia and those with dysplasia based on imaging criteria. Hypoplasia refers to reduced cerebellar volume with normal shape and texture of cerebellum, that is, normal pattern and size of the folia and fissures. Dysplasia refers to abnormal shape or texture of cerebellum, that is, abnormal pattern of foliation and/or gray matter heterotopia.

Unilateral cerebellar hypoplasia (UCH) affects one cerebellar hemisphere with or without the involvement of vermis and is believed to arise from an antenatal vascular (hemorrhagic or ischemic) insult.[2] The clinical presentation of UCH varies from an asymptomatic incidentally detected pathology to a one with severe neurologic deficits. The commonly reported clinical features include developmental and speech acquisition delay, hypotonia, ataxia, and disorders of eye movement.[3] However, atypical features such as seizures as noted in our case have also been reported.[3],[4] The involvement of vermis is often associated with cognitive decline and truncal ataxia.[5] The key imaging feature of cerebellar hypoplasia is asymmetry of the cerebellar hemispheres, which may range in severity from mild asymmetry to near total aplasia. Approximately half of the cases show vermian involvement. The posterior fossa volume is usually normal. Hypoplasia of the ipsilateral superior, middle cerebellar peduncles, and pons is usually seen.[6]

Thus, UCH has a wide spectrum of typical (predictive of cerebellar pathology such as ataxia, hypotonia, and psychomotor retardation) and atypical clinical features (such as seizures and abnormal ocular movements) and a characteristic imaging appearance.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Patel S, Barkovich AJ. Analysis and classification of cerebellar malformations. AJNR Am J Neuroradiol 2002;23:1074-87.  Back to cited text no. 1
    
2.
Massoud M, Cagneaux M, Garel C, Varene N, Moutard ML, Billette T, et al. Prenatal unilateral cerebellar hypoplasia in a series of 26 cases: significance and implications for prenatal diagnosis. Ultrasound Obstet Gynecol 2014;44:447-54.  Back to cited text no. 2
    
3.
Benbir G, Kara S, Yalcinkaya BC, Karhkaya G, Tuysuz B, Kocer N, et al. Unilateral cerebellar hypoplasia with different clinical features. Cerebellum 2011;10:49-60.  Back to cited text no. 3
    
4.
Simon M, Kafritsas D. Unilateral cerebellar hypoplasia. Clin Neuropathol 1992;11:71-3.  Back to cited text no. 4
    
5.
Poretti A, Limperopoulos C, Roulet-Perez E, Wolf NI, Rauscher C, Prayer D, et al. Outcome of severe unilateral cerebellar hypoplasia. Dev Med Child Neurol 2010;52:718-24.  Back to cited text no. 5
    
6.
Poretti A, Boltshauser E, Huisman TA. Prenatal cerebellar disruptions: neuroimaging spectrum of findings in correlation with likely mechanisms and etiologies of injury. Neuroimaging Clin N Am 2016;26:359-72.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]



 

Top
Print this article  Email this article
 
 
  Search
 
  
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (411 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Case Report
   Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed132    
    Printed3    
    Emailed0    
    PDF Downloaded14    
    Comments [Add]    

Recommend this journal