Bilateral oedema of the basal ganglia in an echovirus type 21 infection: complete clinical and radiological normalization

Abstract

A 4-year-old girl with bilateral striatal oedema in association with an echovirus type 21 infection is reported. In the course of a prolonged upper respiratory-tract infection, the patient developed muscular hypotonia, resting tremor, ataxia, sleepiness, hyperaesthesia, and indistinct speech. T,-weighted cranial MRI revealed bilateral oedema of the basal ganglia and the cerebellar peduncles. At follow-up after 3 months MRI changes and clinical symptoms had fully resolved.Bilatenl striatal lesions arc found in numerous diseases of childhood including trauma, hypoxemia-ischaemia, intoxication. and metabolic disorders. Some cases with sudden onset may be traced back to an infectious or paninfectious genesis such as tubcrculosis, mumps, and Mycoplastva pneuniombe infection (Hosenhcrg c't al. 1'992. Roig et al. 1993).We present the case o f a 4-year-old girl who developed bilateral striatal oedema in association with echovirus type 2 1 infection. 'lo our knowledge this is the tint description o f complete clinical and MRI-scan normalization. Case reportThc previously healthy 4-year-old girl presented with an acute upper respiratory-tnct infection. She had conjunctivitis, a cough, and continuous fever u p t o 39°C. On the third day she developed meningism. Examination of CSF in a local hospital showed mild pleocytosis (20 leucocytcs/mm5, mainly lymphocytes) with n o n a l protein and glucose conccntrarions. On day 9 the child was transferred t o o u r hospital with suspected viral meningitis.On admission she presented with general muscle hypotonia. an ataxic gait, a mild resting tremor, indistinct speech, and hyperacsthesia particularly of the arms. The girl was sleepy, but conscious, and tendon reflexes. motor nerve conduction velocity (tibial, peroneal, and ulnar nerve), SSEP (evoked potentials from mcdian and tibial nerve), and ophthalmologic examinations were normal; the EEG demonstrated non-specific slow waves. The CSF examination on day 15 again showed mild pletwosis (47 leucoq.tes/mni', 50% lymphocytes), an elevated protein content of 80.2 mgdL and a normal glucose concentration. Repcated electron-and light-microscopic cxarninations of the CSF well as viral and bacterial cultures were negative. Various blood cultures and repeated serologic examinations including those for influenza, mumps, herpes simplex, varicella zoster, and adeno-, echo-, polio-. and coxsackievirus, as well as Mj~coplrrsma ptieittnotiiae and Borrelia burgdorferi. were negative. The fever of u p to 39OC continued intermittently.A5 an intracranial process was suspected, a cranial CT was carried out o n day 24 and an MRI o n day 36. While the CTand l)euelopnirntnlhfedicitie& CbildNritmlugy 199H. 40. 4 2 1 4 2 3 421