White cerebellum sign a reversal of the normal gray/white matter densities and a relatively increased density of the thalami, brainstem and cerebellum; it is also known as dense cerebellum sign or reversal sign. On Computed Tomography, it is seen as hypodensity of the supratentorial brain with reverse increased attenuation of the cerebellum. This ominous sign is a poor prognostic indicator for patients with brain injury. We document a rare case of white cerebellum sign occurring in an eight year old girl who presented to the emergency department with signs of raised intracranial pressure following Ventriculo-peritoneal shunt revision. Our patient improved significantly after resuscitation with mannitol, she was discharged from hospital with an improved Glasgow Coma Score. Our case presents a new opportunity for management of patients with white cerebellar sign. Mannitol is an antioxidant that decrease H2O2 by upregulating catalases. It is postulated to have played a role in the clinical improvement of our patient. In this review, only one other patient improved after developing a white cerebellar sign, the etiological factor was meningitis as in our case, and the patient had received osmotherapy as well. Mannitol seems to have a protective effect in patients who develop a white cerebellum sign following meningitis.
| Published in | International Journal of Neurosurgery (Volume 2, Issue 2) |
| DOI | 10.11648/j.ijn.20180202.13 |
| Page(s) | 31-34 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2024. Published by Science Publishing Group |
Reversal Sign, Dense Cerebellum, Shunt Malfunction, Intracranial Pressure, Meningitis
| [1] | Han, B. K., et al. “Reversal Sign on CT: Effect of Anoxic/Ischemic Cerebral Injury in Children.” American Journal of Roentgenology, vol. 154, no. 2, 1990, pp. 361–68, doi:10.2214/ajr.154.2.2105031. |
| [2] | Malik, Virender, et al. “‘White Cerebellar Sign’ in Immediate Postpartum Period.” Medical Journal Armed Forces India, vol. 71, Elsevier Ltd, 2015, pp. S163–65, doi:10.1016/j.mjafi.2013.10.018. |
| [3] | Bird, C. Roger, et al. Pathophysiology of " Reverse " Edema in Global Cerebral Ischemia. no. February, 1989, pp. 95–98. |
| [4] | Huisman, T. A. G. M., et al. “The ‘Dark Cerebellar Sign.’” Neuropediatrics, vol. 38, no. 3, 2007, pp. 160–63, doi: 10.1055/s-2007-985909. |
| [5] | Shroff, Manohar M, and Govind B Chavhan. “Twenty Classic Signs in Neuroradiology: A Pictorial Essay.” Indian Journal of Radiology and Imaging, vol. 19, no. 2, 2009, p. 135, doi:10.4103/0971-3026.50835. |
| [6] | Bhoil, Sabina, and Rohit Bhoil. “Reversal Sign: A Red-Flag in Emergency Departments.” Emergency Nurse, vol. 23, no. 7, 2015, pp. 24–25, doi:10.7748/en.23.7.24.s26. |
| [7] | Chalela, Julio A., et al. “The White Cerebellum Sign: An under Recognized Sign of Increased Intracranial Pressure.” Neurocritical Care, vol. 18, no. 3, 2013, pp. 398–99, doi:10.1007/s12028-013-9836-z. |
| [8] | Huang, Benjamin Y. “Brain Injury : Imaging OBJECTIVES; Hypoxic-Ischemic Brain Injury:” RadioGraphics, vol. 28, no. 2, 2008, pp. 417–39, doi:10.1148/rg.282075066. |
| [9] | Jain, Saurabh. “White Cerebellar Sign - a Grave Prognostic Indicator.” Romanian Neurosurgery, vol. 31, no. 3, 2017, pp. 344–45, doi:10.1515/romneu-2017-0056. |
| [10] | Dwarakanath, S., et al. Case Report White Cerebellum Sign – A Case Report and Review of Literature. 2018, pp. 22–23. |
| [11] | White Cerebellum Sign : Red Flag in the Emergency. Vol. 16, no. 5, 2018, p. 131213, doi:10.1148/rg.282075066.2. |
| [12] | Schilte, Clotilde, et al. H 2212. Vol. 43, no. 10, 2015, doi:10.1097/CCM.0000000000001137. |
| [13] | Krishnan, Prasad, and Siddhartha Roy Chowdhury. “ White Cerebellum ” Sign ‑ A Dark Prognosticator. Vol. 5, no. 4, 2014, doi:10.4103/0976-3147.140015. |
| [14] | Maciel, Carolina B., et al. The Neurohospitalist The Reversal Sign : An Ominous. no. November, 2014, pp. 3–5, doi:10.1177/1941874414557081. |
| [15] | Pierce, A. The Acute Reversal Sign: Comparison of Medical and Non-Accidental Injury Patients. 1999, pp. 495–501. |
| [16] | Young, G. Early CT Findings of Global Central Nervous System Hypoperfusion. |
| [17] | Free-Radical Scavenging Properties of Mannitol and Its Role as a Constituent of Hyaluronic Acid Fillers: A Literature Review. 2016, doi:10.1111/ijlh.12426. |
APA Style
Serge Eddy Mba, Kazadi Kalangu, Aaron Musara, Dumisani Ndlovu, Nathaniel Harunangoni Zimani. (2018). White Cerebellum Sign After Ventriculo-Peritoneal Shunt Insertion: A Case Report and Review of the Literature. International Journal of Neurosurgery, 2(2), 31-34. https://doi.org/10.11648/j.ijn.20180202.13
ACS Style
Serge Eddy Mba; Kazadi Kalangu; Aaron Musara; Dumisani Ndlovu; Nathaniel Harunangoni Zimani. White Cerebellum Sign After Ventriculo-Peritoneal Shunt Insertion: A Case Report and Review of the Literature. Int. J. Neurosurg. 2018, 2(2), 31-34. doi: 10.11648/j.ijn.20180202.13
Share This Article
Twitter
Linked In
Facebook
Copy
Download@article{10.11648/j.ijn.20180202.13,
author = {Serge Eddy Mba and Kazadi Kalangu and Aaron Musara and Dumisani Ndlovu and Nathaniel Harunangoni Zimani},
title = {White Cerebellum Sign After Ventriculo-Peritoneal Shunt Insertion: A Case Report and Review of the Literature},
journal = {International Journal of Neurosurgery},
volume = {2},
number = {2},
pages = {31-34},
doi = {10.11648/j.ijn.20180202.13},
url = {https://doi.org/10.11648/j.ijn.20180202.13},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijn.20180202.13},
abstract = {White cerebellum sign a reversal of the normal gray/white matter densities and a relatively increased density of the thalami, brainstem and cerebellum; it is also known as dense cerebellum sign or reversal sign. On Computed Tomography, it is seen as hypodensity of the supratentorial brain with reverse increased attenuation of the cerebellum. This ominous sign is a poor prognostic indicator for patients with brain injury. We document a rare case of white cerebellum sign occurring in an eight year old girl who presented to the emergency department with signs of raised intracranial pressure following Ventriculo-peritoneal shunt revision. Our patient improved significantly after resuscitation with mannitol, she was discharged from hospital with an improved Glasgow Coma Score. Our case presents a new opportunity for management of patients with white cerebellar sign. Mannitol is an antioxidant that decrease H2O2 by upregulating catalases. It is postulated to have played a role in the clinical improvement of our patient. In this review, only one other patient improved after developing a white cerebellar sign, the etiological factor was meningitis as in our case, and the patient had received osmotherapy as well. Mannitol seems to have a protective effect in patients who develop a white cerebellum sign following meningitis.},
year = {2018}
}
TY - JOUR T1 - White Cerebellum Sign After Ventriculo-Peritoneal Shunt Insertion: A Case Report and Review of the Literature AU - Serge Eddy Mba AU - Kazadi Kalangu AU - Aaron Musara AU - Dumisani Ndlovu AU - Nathaniel Harunangoni Zimani Y1 - 2018/12/03 PY - 2018 N1 - https://doi.org/10.11648/j.ijn.20180202.13 DO - 10.11648/j.ijn.20180202.13 T2 - International Journal of Neurosurgery JF - International Journal of Neurosurgery JO - International Journal of Neurosurgery SP - 31 EP - 34 PB - Science Publishing Group SN - 2640-1959 UR - https://doi.org/10.11648/j.ijn.20180202.13 AB - White cerebellum sign a reversal of the normal gray/white matter densities and a relatively increased density of the thalami, brainstem and cerebellum; it is also known as dense cerebellum sign or reversal sign. On Computed Tomography, it is seen as hypodensity of the supratentorial brain with reverse increased attenuation of the cerebellum. This ominous sign is a poor prognostic indicator for patients with brain injury. We document a rare case of white cerebellum sign occurring in an eight year old girl who presented to the emergency department with signs of raised intracranial pressure following Ventriculo-peritoneal shunt revision. Our patient improved significantly after resuscitation with mannitol, she was discharged from hospital with an improved Glasgow Coma Score. Our case presents a new opportunity for management of patients with white cerebellar sign. Mannitol is an antioxidant that decrease H2O2 by upregulating catalases. It is postulated to have played a role in the clinical improvement of our patient. In this review, only one other patient improved after developing a white cerebellar sign, the etiological factor was meningitis as in our case, and the patient had received osmotherapy as well. Mannitol seems to have a protective effect in patients who develop a white cerebellum sign following meningitis. VL - 2 IS - 2 ER -
Information
Email: