White Cerebellum Sign After Ventriculo-Peritoneal Shunt Insertion: A Case Report and Review of the Literature

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