Tina Bastin1, Divya Sudireddy2, Brittany Hansen2, Rachel Caplan1
1Neurology, 2Rheumatology, Boston University Chobanian and Avedisian School of Medicine
Objective:
Recognizing this patient’s unique clinical presentation of isolated cerebellitis without any other Lupus manifestations or neuropsychiatric symptoms.
Background:
Acute cerebellitis is usually seen in the setting of an underlying infection, viral in etiology. It can also be seen as one of many manifestations of a CNS lupus flare, however, isolated cerebellitis is rare.
Results:
A 53 year old woman with a history of SLE-RA and one prior episode of cerebellitis responsive to IVIG, presented to the ED with acute gait instability after recently discontinued hydroxychloroquine and methotrexate. Neurological exam showed left-beating nystagmus with left gaze and dysmetria in the left upper and lower extremity. Respiratory panel was positive for Influenza A. MRI Brain revealed new, non-enhancing T2/ FLAIR hyperintensity in left cerebellar hemisphere. Serum labs showed hypocomplementemia and leukopenia. LP showed mild pleocytic lymphocytosis. She showed rapid clinical improvement after treatment with IV methylprednisolone and IVIG.
Conclusions:
Isolated acute cerebellitis in the setting of a CNS lupus flare is rare. However, in this patient, the relapsing time course, occurrence after discontinuation of immunosuppression, CSF profile, and excellent response to steroids and IVIG were supportive of cerebellitis as a manifestation of SLE.
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