Clinico-radiological spectrum in enterovirus 71 infection involving the central nervous system in children

Lee, Kyung Yeon; Lee, Yun-Jin; Kim, Tae Hyoung; Cheon, Doo‐Sung; Nam, Seokho

doi:10.1016/j.jocn.2013.04.032

Cited by 34 publications

(31 citation statements)

References 19 publications

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“…The demographics features were consistent with the other studies in Asian countries and regions [8–10]. The most common neurological manifestations of brainstem encephalitis induced by EV 71 were myoclonus and tremor in this research, which were similar to the other studies [1,11,12]. 19 (21%) patients complicated a fulminant pulmonary edema; the incident rate was lower than previous study in our hospital located within Shenzhen, and also in Taiwan.…”

Section: Discussionsupporting

confidence: 90%

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New Findings, Classification and Long-Term Follow-Up Study Based on MRI Characterization of Brainstem Encephalitis Induced by Enterovirus 71

et al. 2016

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BackgroundTo report the diversity of MRI features of brainstem encephalitis (BE) induced by Enterovirus 71. This is supported by implementation and testing of our new classification scheme in order to improve the diagnostic level on this specific disease.MethodsNeuroimaging of 91 pediatric patients who got EV71 related BE were hospitalized between March, 2010 to October, 2012, were analyzed retrospectively. All patients underwent pre- and post-contrast MRI scan. Thereafter, 31 patients were randomly called back for follow-up MRI study during December 2013 to August 2014. The MRI signal patterns of BE primary lesion were analyzed and classified according to MR signal alteration at various disease stages. Findings in fatal and non-fatal cases were compared, and according to the MRI scan time point during the course of this disease, the patients’ conditions were classified as 1) acute stage, 2) convalescence stage, 3) post mortem stage, and 4) long term follow-up study.Results103 patients were identified. 11 patients did not undergo MRI, as they died within 48 hours. One patient died on 14th day without MR imaging. 2 patients had postmortem MRI. Medical records and imaging were reviewed in the 91 patients, aged 4 months to 12 years, and two cadavers who have had MRI scan. At acute stage: the most frequent pattern (40 patients) was foci of prolonged T1 and T2 signal, with (15) or without (25) contrast enhancement. We observed a novel pattern in 4 patients having foci of low signal intensity on T2WI, with contrast enhancement. Another pattern in 10 patients having foci of contrast enhancement without abnormalities in T1WI or T2WI weighted images. Based on 2 cases, the entire medulla and pons had prolonged T1 and T2 signal, and 2 of our postmortem cases demonstrated the same pattern. At convalescence stage, the pattern observed in 4 patients was foci of prolonged T1 and T2 signal without contrast enhancement. Follow-up MR study of 31 cases showed normal in 26 cases, and demonstrated foci of prolonged T1 and T2 signal with hyper-intensity on FLAIR in 3 cases, or of prolonged T1 and T2 signal with hypo-intensity on FLAIR in 2 cases. Most importantly, MR findings of each case were thoroughly investigated and classified according to phases and MRI signal alteration.ConclusionsThis study has provided enhanced and useful information for the MRI features of BE induced by EV71, apart from common practice established by previous reports. In addition, a classification scheme that summarizes all types of features based on the MRI signal at the four different stages of the disease would be helpful to improve the diagnostic level.

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Section: Discussionsupporting

confidence: 90%

“…Some of MRI findings of brainstem encephalitis induced by EV71 have been reported by many studies [1,4–6,11,16]. The prominent MRI feature of brainstem encephalitis was the location of primary lesion, which was set on the posterior of the pons and medulla oblongata.…”

Section: Discussionmentioning

confidence: 82%

New Findings, Classification and Long-Term Follow-Up Study Based on MRI Characterization of Brainstem Encephalitis Induced by Enterovirus 71

et al. 2016

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“…This pattern of clinical involvement in EV-71 neurologic disease has often been described as brain stem encephalitis or rhombencephalitis. 9,11,15,[20][21][22][23][24][25] Almost all patients presented with cervical spinal cord T2 hyperintensities, and 9 reported weakness of Ն1 extremity (Fig 3 and On-line Table). This clinical and imaging pattern has been described as AFP in prior case series of EV-71 neurologic disease.…”

Section: Discussionmentioning

confidence: 99%

“…Similar to the cases in our cluster, spinal nerve root enhancement has been previously described in cases of EV-71 neurologic disease. 11,15,[20][21][22]25 Nerve root enhancement is thought to result from either breakdown of the blood-nerve endothelial barrier 32 or radicular vein enhancement. 33 In the case of EV-71 neurologic disease and the current series, possible etiologies could include direct viral infection, inflammation related to Wallerian degeneration from anterior horn cell damage, or a postinfectious autoimmune inflammatory process, as is suspected in Guillain-Barrerelated enhancement.…”

Section: Discussionmentioning

confidence: 99%

MRI Findings in Children with Acute Flaccid Paralysis and Cranial Nerve Dysfunction Occurring during the 2014 Enterovirus D68 Outbreak

Maloney

Mirsky

Messacar³

et al. 2014

AJNR Am J Neuroradiol

161

102

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BACKGROUND AND PURPOSE: Enterovirus D68 was responsible for widespread outbreaks of respiratory illness throughout the United States in August and September 2014. During this time, several patients presented to our institution with acute flaccid paralysis and cranial nerve dysfunction. The purpose of this report is to describe the unique imaging findings of this neurologic syndrome occurring during an enterovirus D68 outbreak.

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“…Although neuroimaging may be normal or show multifocal cortical involvement in this condition, 20 the classical temporal lobe involvement of CNS herpesvirus infection was not seen in our study children. Enterovirus encephalitis commonly produces MRI abnormalities in cerebellar dentate nuclei and the dorsal brainstem, 21 both of which were seen in some of our study subjects. The MRI findings of neurotropic viruses show considerable overlap, 22 and it is possible that some of the findings seen in our patients represent acute CNS viral infection.…”

Section: Discussionmentioning

confidence: 69%

Brain MRI of Children with Retinopathy-Negative Cerebral Malaria

Postels

Birbeck

et al. 2014

The American Society of Tropical Medicine and Hygiene

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Abstract. Our goals were to understand the brain magnetic resonance imaging (MRI) findings in children with retinopathy-negative cerebral malaria (CM) and investigate whether any findings on acute MRI were associated with adverse outcomes. We performed MRI scans on children admitted to the hospital in Blantyre, Malawi with clinically defined CM. Two hundred and seventeen children were imaged during the study period; 44 patients were malarial retinopathy-negative; and 173 patients were retinopathy-positive. We compared MRI findings in children with retinopathy-negative and retinopathy-positive CM. In children who were retinopathy-negative, we identified MRI variables that were associated with death and adverse neurologic outcomes. On multivariate analysis, cortical diffusion weighted imaging (DWI) abnormality and increased brain volume were strongly associated with neurologic morbidity in survivors. Investigations to explore the underlying pathophysiologic processes responsible for these MRI changes are warranted.

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Clinico-radiological spectrum in enterovirus 71 infection involving the central nervous system in children

Cited by 34 publications

References 19 publications

New Findings, Classification and Long-Term Follow-Up Study Based on MRI Characterization of Brainstem Encephalitis Induced by Enterovirus 71

New Findings, Classification and Long-Term Follow-Up Study Based on MRI Characterization of Brainstem Encephalitis Induced by Enterovirus 71

MRI Findings in Children with Acute Flaccid Paralysis and Cranial Nerve Dysfunction Occurring during the 2014 Enterovirus D68 Outbreak

Brain MRI of Children with Retinopathy-Negative Cerebral Malaria

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