To describe a rare case of COVID-19 infection presenting as acute cerebellar ataxia in a pediatric patient.

The COVID-19 virus is well known to cause respiratory tract infections but other body systems can be affected including the nervous system. Most of the reported neurological manifestations of COVID-19 infection occurred sub-acutely between days to weeks after infection onset. Here, we present a pediatric case of COVID-19 infection presenting with associated cerebellar symptoms.

A 10-year-old male with no past medical history presented to the emergency department with a new onset fever (Tmax: 104F), headache, odynophagia, rhinorrhea, diarrhea associated with blurry vision, and ataxia. The patient denied any falls, dysarthria, diplopia, paresis, hypoesthesias, bladder or bowel incontinence. On exam T: 98.9F, HR: 65, BP: 107/66, RR: 20. Normal physical exam, on neurological exam patient, was alert and oriented, he did not have paresis, hypoesthesia but had ataxia, bilateral nystagmus, dysdiadochokinesia, dysmetria with finger-to-nose and heel-to-shin testing, he was unable to walk unassisted, had wide-based gait, altered heel, toe, and tandem walking. No papilledema was observed on fundoscopy. CBC, CMP were unremarkable, CT head did not show any acute intracranial abnormality. Infectious workup showed a positive COVID-19 polymerase chain reaction and negative blood cultures. Lumbar puncture revealed normal protein and glucose levels with no pleocytosis, the patient had extensive negative serology testing for autoimmune, demyelinating, and alternative infectious etiologies. Brain and cervicothoracic spine MRIs with and without contrast were normal. The patient was diagnosed with viral cerebellitis secondary to COVID-19 infection, and he was started on intravenous methylprednisolone 1 gram for 5 days with symptomatic improvement, the patient was able to walk with minimal assistance by the end of the hospital stay and was discharged with a prednisone taper.

Neurological manifestations like cerebellar ataxia can be the presenting symptomatology of acute COVID-19 infection.