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Temporal lobe involvement in Japanese encephalitis: problems in differential diagnosis
S K Handique1, R R Das, K Barman
1Department of Radiology and Imaging, Institute of Neurological Sciences, Dispur, Assam, India.
AJNR. American Journal of Neuroradiology
|May 12, 2006
Summary
Japanese encephalitis (JE) can affect the temporal lobe, primarily the hippocampus, distinguishing it from Herpes simplex encephalitis (HSE). Concurrent thalamic, substantia nigra, and basal ganglia lesions aid differentiation in JE imaging.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Japanese encephalitis (JE) and Herpes simplex encephalitis (HSE) can present with overlapping imaging findings.
- Temporal lobe involvement is a key feature differentiating HSE but can also occur in JE.
Purpose of the Study:
- To characterize the temporal lobe involvement pattern in Japanese encephalitis (JE).
- To identify imaging features that differentiate temporal lobe involvement in JE from HSE.
Main Methods:
- Retrospective analysis of CT and MR imaging in 62 patients diagnosed with JE.
- Diagnosis of JE confirmed by cerebrospinal fluid (CSF) IgM enzyme-linked immunosorbent assay.
Main Results:
- 17.7% of JE patients showed temporal lobe involvement, predominantly affecting the hippocampus.
- Concurrent thalamic, substantia nigra, and basal ganglia involvement was observed in most JE cases.
- CT scans were less sensitive than MR imaging in detecting temporal lobe lesions in JE.
Conclusions:
- The characteristic temporal lobe involvement in JE, primarily the hippocampus, aids differentiation from HSE.
- Concurrent thalamic, substantia nigra, and basal ganglia lesions are crucial differentiating features.
- In severe cases, laboratory tests are essential, and empirical antiviral therapy may be considered.
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