P99 – 2226: Acute cerebellitis and mutism associated with Rotavirus diarrhoeal illness

Objective To describe a rare case of acute cerebellitis and mutism associated with Rotavirus diarrhoeal illness. Background Rotavirus is the most common organism responsible for viral gastroenteritis in infancy and early childhood. The infection is usually localised in the intestine and the illness is self-limiting. Neurological manifestation mainly seizures are well described and reported. We present a rare case of cerebellitis and mutism associated with Rotavirus diarrhoeal illness. Methods Retrospective case note review. Results A previously healthy 2 years and 9 months old girl was admitted with 4 days history of vomiting, diarrhoea, fever and lethargy. 24hours after admission she had a focal seizure and was encephalopathic. She was treated for encephalitis. Her tone and power were reduced but reflexes were elicitable. She stopped talking and remained hypotonic and ataxic. Her blood tests for infection and metabolic conditions were unremarkable. Her CSF culture and viral PCR including Rotavirus were negative. Her MRI showed cerebellitis and EEG showed features of Encephalopathy. We hypothesise that her encephalitis resulting in cerebellitis was possibly due to Rotavirus. She needed neuro-rehabilitation and she started speaking single word after a month of stay in hospital. Her parental recognition improved. At 6 month follow up, she is able to walk but is still ataxic, her speech has improved. Conclusion Rotavirus infection related central nervous system involvement can be associated with seizure and encephalitis but very rarely leading to cerebellitis and mutism. Rotavirus RNA in CSF can be confirmatory but found only in less than half of cases. The mechanism of CNS invasion in Rotavirus infection is not very clear and various hypotheses have been suggested. Rotavirus cerebellitis exhibited unique clinical and MR imaging features. Involvement of the cerebellar white matter/nuclei may be associated with the mutism. The prognosis is guarded and recovery time may be prolonged.