PMC6296698_01
Timeliness of the process of the patient's follow up.
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F1
Our first clinical suspicion was cerebellitis or post infectious ataxia (Figure 1) so we ordered intravenous ceftriaxone, intravenous pantoprazole, and ondansetron for two days.
Brain CT scan without contrast (left) on first day showing dim hypodensity in the left cerebellar hemisphere and sagittal plane of brain MRI (right) on second day
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F2
The first EEG report was mildly abnormal due to some spike and wave discharges (Figure 2 Left) and in the last EEG report, there were some background attenuations without epileptiform activity (Figure 2 Right).
First EEG; Taken while the patient is sleep (left), Second EEG; Taken while the patient is awake (right).
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F3
Findings on the first brain CT scan were a dim hypodensity in the left cerebellar hemisphere accompanied by a mild generalized ventriculomegaly (Figure 3 Left). In the MRI report, there were abnormal low T1 and high T2 signal intensity in left cerebellar hemisphere involving superior and middle cerebellar peduncles in the same side as well (Figure 3 Right , Figure 4 Middle), restriction was noted in this region.
Cerebellar diffusion-weighted image (ADC map) (left) and axial T2 image (middle) showing infarcts at left cerebellar hemisphere on the second day and normal brain MRV (right).
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F4
The MRV's result was also normal (Figure 4 Right). In the MRI report, there were abnormal low T1 and high T2 signal intensity in left cerebellar hemisphere involving superior and middle cerebellar peduncles in the same side as well (Figure 3 Right , Figure 4 Middle), restriction was noted in this region. DWI findings were consistent with cerebellar infarction in this region (Figure 4 Left).
Brain CT scan on fourth day showing infarction on the same area along with obstructive hydrocephaly (left), Brain CT scan after inserting the drain in left lateral ventricle (middle), Brain CT scan after hemispherectomy of the left hemisphere of the cerebellum and extracting the drain (right).
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F5
On the second brain CT scan that was 48 h after the MRI, there was an intense hypodensity arising from cytotoxic edema in the left cerebellar hemisphere with concomitant cortical entanglement exerted pressure on fourth ventricle and had resulted in hydrocephaly, severe ventriculomegaly was also seen in the CT scan (Figure 5 Left) . On the third brain CT which was after the patient's surgery, there were evidence of craniotomy in occipital bone on the left side and hemispherectomy of the left hemisphere of the cerebellum, the drain in the left lateral ventricle was in its appropriate position (Figure 5 Middle). The last brain CT scan had no new findings and the drain was extracted from the brain (Figure 5 Right).