Cerebellar Disorders: A Diagnostic Approach with Clinicoanatomical Correlation

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Investigations revealed hemoglobin: 10 gm/dL, total leukocyte count: 5000 cells/mm 3 , N 80%; L 20%, platelets: 180,000 cells/ mm 3 .CSF study was done, which showed: cell count: 5 cells/mm 3 , all lymphocytes; protein: 108 mg/dL; sugar: 40 mg/dL; culture: no growth; ADA: 5.5 IU/L; CBNAAT: MTB not detected.Serology: HBsAg, anti-HCV: nonreactive, VDRL: nonreactive.MRI brain was done, which showed prominent small hyperintensities seen in the cerebellum (Fig. 2), and MR spectroscopy showed the presence of lipid peaks, no reduction in NAA, and choline/creatinine ratio not increased. IntroductIonThe cerebellum is an important component of the hindbrain which is essential for coordinating voluntary movements, balance, posture and fine motor control.Its dysfunction is clinically characterized by difficulty in coordination, imbalance, and gait abnormalities.A spectrum of disorders can lead to cerebellar dysfunction, which includes inherited disorders as well as acquired causes ranging from vascular, immune-mediated, metabolic, toxin-mediated, neoplastic, and paraneoplastic diseases as well as various infections.[1][2][3] Here, we present two cases of cerebellar involvement followed by anatomic correlation of manifestations and a diagnostic approach. case descrIptIons Case 1A 45-year-old male, newly diagnosed HIV seropositive, presented with chief complaints of low-grade fever, productive cough, and shortness of breath for 1 month.He was a known case of bronchial asthma but not on any regular medications.On examination, the patient was drowsy (GCS 11/15), disoriented, and tachypneic.Pulse was 100/min, BP: 110/70 mm Hg, and SpO 2 : 97%.Chest examination revealed bilateral rhonchi.On neurological examination, Reflexes were brisk, and both plantar responses were flexor without any loss of tone.No nuchal rigidity.Patient was managed conservatively with antibiotics, and the shortness of breath reduced and sensorium improved.Repeat neurological examination showed reflexes to be brisk, past-pointing in both fingers (Fig. 1), positive Romberg's test, swaying while walking, and tended to fall on either side while walking.Sensory system was found to be intact in all limbs.

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