Magnetic Resonance Imaging Findings in a Case of Congenital Rubella Encephalitis

Sawlani, Vijay; Shankar, Jai; White, Cathy

doi:10.1155/2013/858302

Cited by 11 publications

(9 citation statements)

References 9 publications

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“…23 A case report discussing a 7-year-old girl with a history of CRS presented MRI results significant for periventricular and subcortical white matter T2/fluid attenuation inversion recovery (FLAIR) hyperintense foci, cystic changes in the bilateral temporal lobes, and small periventricular calcifications. 24 A case series from Japan demonstrated abnormal T1 and T2 prolongation of the white matter in all seven patients scanned by MRI with severe clinical manifestations of CRS. They postulated that lateral ventricular dilation as opposed to white matter abnormality has a closer relation to severity of sequelae of CRS.…”

Section: Discussionmentioning

confidence: 90%

Congenital Rubella Syndrome: Clinical and Imaging Features

Ghanaat

Soleiman

2019

Journal of Pediatric Neurology

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Congenital rubella syndrome is rare in high-income countries. A 19-year-old pregnant female, who recently immigrated to the United States, presented to clinic for prenatal care at 21 weeks of gestational age. Prenatal ultrasound demonstrated twin gestations with a cleft lip present in twin B. Ultrasound at 36 weeks of gestational age demonstrated fetal demise in twin A and growth restriction in twin B. Twin B was delivered via emergency C-section due to fetal distress. The viable neonate demonstrated multiple abnormalities including microcephaly, patent ductus arteriosus, atrial septal defect, cardiomegaly, pulmonary edema, congenital polar cataracts, congenital adrenal hyperplasia, thyroiditis, cleft palate/lip, and abnormal hearing.

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Section: Discussionmentioning

confidence: 90%

Congenital Rubella Syndrome: Clinical and Imaging Features

Ghanaat

Soleiman

2019

Journal of Pediatric Neurology

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“…Associated features are cerebellar hypoplasia and polymicrogyria. CT use is limited because of radiation exposure and typically shows ventriculomegaly, multifocal regions of WM hypodensity coexisting with periventricular, and basal ganglia calcifications and cysts [ 8 , 50 , 51 , 52 , 53 ]. Progressive rubella panencephalitis (PRP) is a late and rare presentation of CRS with an incidence of 1 in 6000 cases of rubella infection.…”

Section: Torchmentioning

confidence: 99%

From Fetal to Neonatal Neuroimaging in TORCH Infections: A Pictorial Review

et al. 2022

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Congenital infections represent a challenging and varied clinical scenario in which the brain is frequently involved. Therefore, fetal and neonatal neuro-imaging plays a pivotal role in reaching an accurate diagnosis and in predicting the clinical outcome. Congenital brain infections are characterized by various clinical manifestations, ranging from nearly asymptomatic diseases to syndromic disorders, often associated with severe neurological symptoms. Brain damage results from the complex interaction among the infectious agent, its specific cellular tropism, and the stage of development of the central nervous system at the time of the maternal infection. Therefore, neuroradiological findings vary widely and are the result of complex events. An early detection is essential to establishing a proper diagnosis and prognosis, and to guarantee an optimal and prompt therapeutic perinatal management. Recently, emerging infective agents (i.e., Zika virus and SARS-CoV2) have been related to possible pre- and perinatal brain damage, thus expanding the spectrum of congenital brain infections. The purpose of this pictorial review is to provide an overview of the current knowledge on fetal and neonatal brain neuroimaging patterns in congenital brain infections used in clinical practice.

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“…Pathology of youths approximately ages 8–20 who died after PRP demonstrated significant volume loss with white matter destruction, vasculitis, cerebellar atrophy, fulminant necrosis, and old infarcts. Theories on the cause often include inflammatory insults, cerebral vasculitis, and to a lesser extent direct viral inhibition of growth and destruction of cells (Kuroda and Matsui, 1997 ; Webster, 1998 ; Sawlani et al, 2013 ).…”

Section: Neuropathology In Rubella and Autismmentioning

confidence: 99%

“…There are several case reports of neurological MRI findings in CRS children. An MRI of a case documented in 2013 showed cystic encephalomalacia, periventricular calcifications, atrophic changes in the temporal lobe, and lesions consistent with gliosis and demyelination (Sawlani et al, 2013 ). Another case from 2013 showed “diffuse leukoencephalopathy with subcortical anterior temporal cysts, which showed spontaneous improvement during a period of 3 years” (Severino et al, 2014 ).…”

Section: Neuroimaging In Rubella and Autismmentioning

confidence: 99%

“…These authors could not suggest a lower titer to fully protect against rubella reinfection. Since that study in 2000, several more cases of CRI/CRS have been reported, as born to: a woman with an anti-rubella titer of > 1:16 (Aboudy et al, 2000 ); a physician mom with a low-titer early in pregnancy and likely infected at work in a hospital with a large immigrant population (Hutton and Hutton, 2014 ); a woman immunized 14 years prior with a pre-pregnancy titer of 1:16 and a 9-week titer of 1:512 (Ushida et al, 2003 ); a woman with an early anti-rubella titer interpreted as “immune” early in pregnancy (Numazaki and Fujikawa, 2003 ); a woman vaccinated 5 years before the birth of her child with a documented anti-rubella titer >400 IU/ml 5 years before her pregnancy to which the authors state she must have had a quickly waning titer or low avidity antibodies (Pitts et al, 2014 ); and a mother with an early pregnancy anti-rubella titer >15 IU/ml and HIA 1:1024 (Sawlani et al, 2013 ). To summarize these cases of reinfection in pregnancy, several occurred after vaccination within 4–7 years, with anti-rubella titers >15 IU/ml, and with high early pregnancy titers initially thought to reflect immunity, but in hindsight reflecting reinfection.…”

Section: Rubella Vaccine Effectivenessmentioning

confidence: 99%

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Does Rubella Cause Autism: A 2015 Reappraisal?

Hutton

2016

Front. Hum. Neurosci.

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In the 1970s, Stella Chess found a high prevalence of autism in children with congenital rubella syndrome (CRS), 200 times that of the general population at the time. Many researchers quote this fact to add proof to the current theory that maternal infection with immune system activation in pregnancy leads to autism in the offspring. This rubella and autism association is presented with the notion that rubella has been eliminated in today’s world. CRS cases are no longer typically seen; yet, autistic children often share findings of CRS including deafness, congenital heart defects, and to a lesser extent visual changes. Autistic children commonly have hyperactivity and spasticity, as do CRS children. Both autistic and CRS individuals may develop type 1 diabetes as young adults. Neuropathology of CRS infants may reveal cerebral vasculitis with narrowed lumens and cerebral necrosis. Neuroradiological findings of children with CRS show calcifications, periventricular leukomalacia, and dilated perivascular spaces. Neuroradiology of autism has also demonstrated hyperintensities, leukomalacia, and prominent perivascular spaces. PET studies of autistic individuals exhibit decreased perfusion to areas of the brain similarly affected by rubella. In both autism and CRS, certain changes in the brain have implicated the immune system. Several children with autism lack antibodies to rubella, as do children with CRS. These numerous similarities increase the probability of an association between rubella virus and autism. Rubella and autism cross many ethnicities in many countries. Contrary to current belief, rubella has not been eradicated and globally affects up to 5% of pregnant women. Susceptibility continues as vaccines are not given worldwide and are not fully protective. Rubella might still cause autism, even in vaccinated populations.

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Magnetic Resonance Imaging Findings in a Case of Congenital Rubella Encephalitis

Cited by 11 publications

References 9 publications

Congenital Rubella Syndrome: Clinical and Imaging Features

Congenital Rubella Syndrome: Clinical and Imaging Features

From Fetal to Neonatal Neuroimaging in TORCH Infections: A Pictorial Review

Does Rubella Cause Autism: A 2015 Reappraisal?

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