Key clinical message

Cerebellar infarction is an exceptionally rare cause of status epilepticus in infants, often presenting with non-specific symptoms that mimic other conditions such as febrile seizures, metabolic disorders, or infections. This case highlights the importance of thorough evaluation in infants presenting with seizures, particularly when associated with atypical clinical features, a significant family history of neurological conditions, or consanguinity. Early neuroimaging, particularly MRI, is critical for identifying structural causes like cerebellar infarction and associated vascular anomalies, which may predispose infants to ischemic events. Elevated inflammatory markers, such as CRP, may indicate a proinflammatory or hypercoagulable state contributing to vascular injury. Management requires prompt seizure control, often with antiepileptic drugs like levetiracetam, along with supportive care addressing nutritional deficiencies and systemic inflammation. Genetic counseling and advanced testing should be considered in similar cases to explore potential hereditary predispositions, particularly in resource-limited settings where diagnostic challenges may arise.