Cerebellar imaging - an important signpost in paediatric neurology

Cerebellar function has traditionally been viewed as limited to the control of voluntary movement. There is increasing clinical and experimental evidence that the cerebellum is involved in nonmotor behaviours and cognitive operations. In acquired and congenital cerebellar lesions such deficits can be demonstrated by appropriate testing. These nonmotor functions explain, at least in part, why many children with congenital cerebellar deficits or malformations first come to medical attention because of developmental delay. While the outcome of defined cerebellar syndromes, such as Dandy-Walker and Joubert, is documented, the relevance of cerebellar involvement related to prenatal (ischaemic) insults and of those observed in the context of more widespread CNS disorganization is not well understood. The cerebellum is vulnerable to prenatal infections and to many toxins and metabolic disorders, but not to perinatal and postnatal hypoxic-ischaemic injury. Consideration of cerebellar involvement and analysis of imaging patterns are crucial in recognizing many neuropaediatric disorders and helpful in guiding appropriate additional investigations.