A Case of Acute Cerebellitis with Flutter-like Oscillation

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  • Flutter-like oscillationを認めた急性小脳炎例
  • 臨床 Flutter-like oscillationを認めた急性小脳炎例
  • リンショウ Flutter-like oscillation オ ミトメタ キュウセイ ショウノウエンレイ

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Abstract

We report herein on our experience in one case of cerebellitis in which the presence of flutter-like oscillation (FLO) helped in the diagnosis and treatment. A 59-year-old man underwent a medical examination for gait impairment. He presented with transient, horizontal and pendular ocular oscillation. This abnormal eye movement was diagnosed as flutter-like oscillation (FLO). The abnormal ocular motion was a characteristic finding in his neuro-otological findings, and although cell counts and protein concentration in his cerebrospinal fluid were significantly elevated, the results of his blood test and brain MRI findings (diffusion-weighted image, Gd-enhanced T1-weighted image) were unremarkable. Brain perfusion scintigraphy revealed modest increase in cerebellar blood flow. After treatment with intravenous immunoglobulin and immunoadsorption therapy, the FLO disappeared. FLO is a rapid abnormal ocular movement to the left and right of the transient lasting for a few seconds. These are important findings when making the diagnosis. FLO has been reported to be mostly due to a cerebellar deficit. Cerebellitis is a disease that is mainly associated with trunk ataxia, poor coordination of the extremities, dysarthria, and abnormal ocular movements. In many cases, cerebellitis is preceded by symptoms of infection symptoms preceding, but many cases have also been reported where such symptoms are unclear. As for the pathogenesis of cerebellitis, direct bacterial and viral infection, a post-infection-associated immunological mechanism of and activation of a subclinical virus have all been considered. We could not find any obvious signs of a preceding infection in our case and various virus antibodies were also negative. Although the findings of protein cell dissociation were recognized in the cerebrospinal fluid examination carried out as one of the assessments, the cerebellitis in this patient was identified by immunologically. Our results suggested that a diagnosis of cerebellitis could be important for the observation of ocular movement.

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