A 17-year-old male was brought to the emergency department by his father complaining of sudden falling, inability to move his leg properly, and slurred speech. He had developed chickenpox 12 days prior and was experiencing severe headaches the night before being brought in. Upon examination, he displayed signs of ataxia including unsteady gait and loss of coordination, as well as dysarthria. MRI showed mild hyperdensity in the cerebellum and CSF testing was positive for VZV. The patient was diagnosed with varicella encephalitis followed by acute cerebellar ataxia and treated intravenously with saline and acyclovir.

1. A 17 year old M child taken to the
emergency department by his father
complained of sudden fall in floor , don’t
able to move leg properly ,slurring of
voice.

2.  He live in a hostal where he develop some kind of blisters in
face, trunk and had normal fever. For that he went to the Out
patient Department and doctor make diagnosis as chicken pox
and prescribed Antipyretic for fever and advised to take plenty
of fluid and take rest. He came back to the home
After 12 day in the evening he developed severe headaches for
that he take ibuprofen painkiller ,Next morning when he get up
not able speech properly and sudden fall down in floor and
bought to the hospital by father.
History of patient:-

3. Objective examination
Condition of patient is satisfactory and conscious ,
temperature is 37.4 , pleomorphic blister seen on face and
trunk area
Heart sound is clear and rhythmic.pulse rate 79b/min ,
blood pressure 122/80.lymph node are not enlarged.
Abdominal organ is normal in shape, no pain feel on
palpation
BMI-21kg/m2 .
CVS S1 S2 hear no murmur

4. Neurological status
More space between leg when walking (ataxia gait),
Inability to perform fast movement (adiadochokinesia) ,
Dysarthria ( inability to speak clearly),
Loss of coordination during walking.,
Normal eye movement
Muscle tone is normal,pharyngeal and gag reflex are normal,
patient swallowing food and water him own.
Pass-pointing positive (finger nose test )

5. Investigation
MRI shown mild hyper-density in cerebellum area.
CSF real time PCR FOR Adenovirus, enterovirus,
EBV, HHV7, HHV6, human parechovirus ,parvo
virus b19 , Cytomegalovirus,herpes simplex virus
1,2 is negative
VZV Is detected in csf

6. Investigati
on
Blood count
Hb 13.1
TLC 8480
PLT 4.87 lakh
N/L/M 74.6/56.5/6.5

7. CSF
examination
Gross Clear
Protein 560mg/dl
Glucose 57mg/dl
Cell 13 per mul
Chloride 117Meq/l

8. Diagnosis ??

9. VERECELLA ENCEPHALITIS FOLLOWED
BY ACUTE CEREBELLAR ATAXIA

10. Treatment
 Intravenous Normal saline
 Intravenous Acyclovir

11. Thank you!