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MR imaging findings of enteroviral encephaloymelitis: an outbreak in Taiwan
1Department of Radiology, China Medical College Hospital and School of Medicine, Taichung, Taiwan.
Background And Purpose:
An outbreak of enterovirus infection occurred in Taiwan from late spring to early fall of 1998. Most of the pediatric infections presented as hand-foot-mouth disease (HFMD) and herpangina. A small portion of patients had symptoms of polio-like encephalitis and paralysis. The purpose of this study was to review the MR imaging findings in CNS involvement of enterovirus infection.
Methods:
Twenty patients who had HFMD and clinical encephalitis were examined with MR imaging. T1-weighted and T2-weighted MR images were obtained. From the rectum, throat, CSF, and peripheral blood, the presence of enterovirus 71 (EV 71) was determined by virus culture, immunofluorescent microscopy, immunologic dot blotting, and reverse-transcription polymerase chain reaction.
Results:
MR imaging studies of 20 patients showed hyperintensity in the brain stem and spinal cord in 15 patients, as seen on T2-weighted images. The major CNS lesions were in the medulla oblongata, pons, midbrain, and the dentate nuclei of the cerebellum. In some cases, the lesions involved the spinal cord (three cases) as well as the thalamus (two cases) and putamina (one case). Five patients had normal MR imaging results. After the appropriate management for tachycardia and tachypnea, 18 patients recovered within 1 to 2 weeks. In the follow-up MR imaging examination of five patients, the lesions completely disappeared within 2 weeks to 2 months. In two patients who were still respirator-dependent, MR imaging showed the tissue destruction in the posterior portions of the medulla, pons, and the ventral horns of cervical spinal cord. In one patient, most of midbrain was damaged. The presence of EV 71 was detected in specimens from 18 patients.
Conclusion:
Because EV 71 was identified in 18 patients, and no other virus was detected, EV 71 was determined to be the major causative agent of this encephalomyelitis. Brain stem and cervical spinal cord involvement are characteristic findings of enteroviral encephalomyelitis.
Insights
Enterovirus 71 (EV 71) caused a 1998 Taiwan outbreak of polio-like encephalitis. MR imaging revealed characteristic brain stem and spinal cord lesions in affected children.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- An enterovirus infection outbreak occurred in Taiwan in 1998.
- Pediatric cases primarily presented as hand-foot-mouth disease and herpangina.
- A subset of patients developed severe central nervous system (CNS) complications, including encephalitis and paralysis.
Purpose of the Study:
- To review the magnetic resonance (MR) imaging findings in children with CNS involvement due to enterovirus infection.
- To identify characteristic imaging patterns associated with enteroviral encephalomyelitis.
Main Methods:
- Twenty pediatric patients with hand-foot-mouth disease and clinical encephalitis underwent MR imaging (T1- and T2-weighted).
- Enterovirus 71 (EV 71) was detected using various methods including virus culture and RT-PCR from rectal, throat, CSF, and blood samples.
- Clinical outcomes and follow-up imaging were assessed.
Main Results:
- Fifteen of 20 patients showed T2-weighted hyperintensities in the brain stem (medulla, pons, midbrain) and/or spinal cord.
- Lesions were also observed in the dentate nuclei, thalamus, and putamina in some cases.
- EV 71 was confirmed in 18 patients; 18 patients recovered within 1-2 weeks, while two respirator-dependent patients showed significant medullary/pontine/spinal cord destruction.
Conclusions:
- Enterovirus 71 was identified as the primary causative agent of the observed encephalomyelitis.
- Characteristic MR imaging findings include involvement of the brain stem and cervical spinal cord.
- These imaging findings are indicative of enteroviral encephalomyelitis.