Abstract:

Objective To characterize the clinical features, diagnostic workup, and management of acute cerebellitis caused by Epstein-Barr virus (EBV). MethodsWe performed a retrospective case analysis of a 53-year-old man diagnosed with EBV-associated acute cerebellitis at our institution, reviewing his presenting symptoms, laboratory and imaging findings, therapeutic interventions, and clinical course, and contextualized the case with a literature review. Results The patient presented with acute onset of dizziness, unsteady gait, dysarthria, and gaze-evoked nystagmus. CSF analysis revealed pleocytosis (66×10⁶/L) and elevated total protein (586.6 mg/L). Targeted next-generation sequencing (tNGS) of CSF identified 2, 402 EBV reads. Serologic testing showed elevated anti-EBV viral capsid antigen (VCA) IgA, and peripheral blood EBV DNA was positive. The patient was treated with intravenous acyclovir and systemic glucocorticoids, after which neurological symptoms improved substantially. Conclusion Although uncommon, EBV-related cerebellitis should be included in the differential diagnosis of acute cerebellar syndromes, as it may be mistaken for cerebrovascular events. Early consideration of viral etiologies and timely laboratory evaluation, including serology and CSF viral testing, can facilitate diagnosis and allow prompt initiation of antiviral and immunomodulatory therapy, which may improve outcomes.

Key words: encephalitis, EB virus, ataxia, targeted next-generation sequencing