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Unusual MRI findings in an immunocompetent patient with EBV encephalitis: a case report

Paola Di Carlo1, Marcello Trizzino, Lucina Titone

  • 1Dipartimento di Scienze per la Promozione della Salute, Università di Palermo, Italy. pdicarlo@unipa.it

BMC Medical Imaging
|March 26, 2011
PubMed
Abstract

Insights

Epstein-Barr virus (EBV) encephalitis in immunocompetent adults can cause reversible white matter changes. A normal diffusion-weighted MRI (DWI) during acute infection suggests a favorable prognosis for CNS involvement.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Neuroradiology

Background:

  • Epstein-Barr virus (EBV) is known to impact the central nervous system (CNS).
  • EBV encephalitis typically presents with neurological symptoms.

Observation:

  • An immunocompetent patient with EBV encephalitis exhibited unique serial brain Magnetic Resonance Imaging (MRI) findings.
  • Acute diffusion-weighted imaging (DWI) was normal, but Fast Relaxation Fast Spin Echo T2 images revealed diffuse white matter signal intensity changes.

Findings:

  • The MRI enhancement pattern indicated an inflammatory response localized to the brain's microcirculation.
  • Treatment with acyclovir and corticosteroids led to normalization of MRI signal intensities and clinical recovery within three weeks.

Implications:

  • EBV can cause diffuse, reversible white matter involvement in immunocompetent adults during acute mononucleosis.
  • A negative acute-phase DWI sequence may predict favorable outcomes in severe EBV CNS infections.
  • Further research is needed to identify instrumental data that can differentiate viral lesions from other causes during the acute phase of CNS disease.

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