Acute Cerebrocerebellar Ataxia

Five years ago I reported an instance of acute cerebellar ataxia, and reviewed the cases occurring in children, so far as examination of medical literature had brought them to my notice.1 Since that time three other cases have come under my care.An occurrence as fre- quent as this, although undoubtedly dependent in some measure on coincidence, is certainly an indication that the disease is not as uncom- mon as we would suppose from the scanty reference to it in medical literature, and in most textbooks on diseases of children.The convic- tion of the existence of this apparently unsuspected frequency is the motive for the present communication.Encephalitis is, as is well known, of not uncommon occurrence.In most cases, the large brain bears the brunt of the attack; but it is perfectly possible for the cerebellum to share in the process, or even to exhibit the chief symptoms.It is doubtful whether the process is limited to the cerebellum in any case.Certainly, as far as published case records go, symptoms pointing to involvement of the cerebrum also have always been observed.It is equally true that in the large majority of cases of acute hemorrhagic encephalitis cerebellar symp¬ toms are absent.What relation the lethargic encephalitis bears to other varieties of encephalitis is a matter which only time can solve, and cannot be discussed at length in this connection.The peculiar prominence of lethargy and asthenia seen in that disease is not characteristic of the majority of cases of other forms, and yet may occur in any of them, as S. Kinnear Wilson 2 pointed out.One of the instances of cerebellar ataxia which I have to report strongly suggests lethargic encephalitis. REPORT OF CASESFollowing are the histories of the four cases, with comments on them; the first case, already published, is abstracted for the sake of completeness.In view of my former communication on the subject, any complete discussion of etiology and diagnosis would be repetition.Case 1.-Susie R., aged 5 years; negative family and personal history; was taken ill Jan. 4, 1915, with cold in the head and cough.Influenza was prevailing in Philadelphia at the time.