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Sequential MRI, SPECT and PET in respiratory syncytial virus encephalitis
K Hirayama1, H Sakazaki, S Murakami
1Department of Paediatrics, Izumi Municipal Hospital, 4-10-10 Fuchu-cho, Izumi City, Osaka 594, Japan.
Abstract:
We report on a 3-year-old girl with respiratory syncytial virus (RSV) encephalitis manifested by disturbance of consciousness, conjugate eye deviation, anuria, truncal ataxia and intention tremor. T2-weighted magnetic resonance imaging (MRI) showed hyperintense areas in the cerebellar cortex. No lesion was detected in the cerebral cortex, pons or spinal cord. The hyperintense areas in the cerebellar cortex diminished with recovery from the clinical manifestations and had resolved 2 months after onset. The MRI lesions in the cerebellum were considered to be due to oedema. SPECT and positron emission tomography (PET), performed 3 months after onset, disclosed areas of hypoperfusion and hypometabolism at the same sites. One year after onset, MRI showed mild atrophy of the cerebellum. Hypoperfusion on SPECT and hypometabolism on PET remained. Neuroimaging showed that ataxia and tremor in this case were the result of cerebellitis. The patient has no neurological deficit except for mild truncal ataxia. This patient is a rare example of RSV encephalitis.
Insights
Respiratory syncytial virus (RSV) encephalitis in a child caused cerebellar inflammation, leading to ataxia and tremor. Neuroimaging confirmed cerebellitis, with symptoms resolving but cerebellar changes persisting.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neuroimaging
Background:
- Respiratory syncytial virus (RSV) can cause central nervous system infections, including encephalitis.
- Encephalitis presents with diverse neurological symptoms, requiring accurate diagnosis and monitoring.
Observation:
- A 3-year-old girl presented with altered consciousness, conjugate eye deviation, anuria, truncal ataxia, and intention tremor.
- Cerebellar hyperintensities on MRI, indicative of edema, were observed and resolved over two months.
- SPECT and PET scans revealed persistent hypoperfusion and hypometabolism in the cerebellum.
Findings:
- Neuroimaging confirmed cerebellitis as the cause of ataxia and tremor.
- Initial MRI lesions resolved, but mild cerebellar atrophy was noted one year later.
- Persistent hypoperfusion and hypometabolism suggest long-term cerebellar dysfunction.
Implications:
- This case highlights RSV encephalitis's potential to cause significant cerebellar involvement.
- Neuroimaging is crucial for diagnosing and understanding the pathophysiology of RSV-induced cerebellitis.
- Early diagnosis and management may improve outcomes for children with RSV encephalitis.