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Atypical rabies with MRI findings: clue to the diagnosis
Arvind Kumar Vaish1, Nirdesh Jain, Lokesh Kumar Gupta
1Department of Internal Medicine, CSM Medical University, Lucknow, India. vaish12@rediffmail.com
Abstract:
Rabies is known for most as a fatal infectious disease, mainly transmitted to both humans and animals through bites by rabid animals. In its classical form, rabies is well recognised, but when it presents atypically in paralytic form, it may become difficult to distinguish from Guillain-Barré syndrome (GBS) or myelitis, particularly where history is not forthcoming or concealed. The authors report here an atypical case of paralytic rabies presenting with descending paralysis followed by furious form where clue to suspicion was MRI findings. Imaging in rabies is seldom done. MRI findings of rabies encephalitis are well known, but in myelitis these need to be further characterised. The authors present MRI findings in a confirmed case of rabies myelitis. The differential diagnosis of the imaging findings as well as the role and the relevance of imaging in the diagnosis of this disease are discussed.
Insights
Atypical paralytic rabies can mimic Guillain-Barré syndrome (GBS). MRI findings were crucial in diagnosing a rare case of rabies myelitis, highlighting the role of imaging in atypical presentations.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Rabies is a fatal zoonotic disease typically transmitted via animal bites.
- Atypical paralytic rabies can be misdiagnosed as Guillain-Barré syndrome (GBS) or myelitis.
- Distinguishing paralytic rabies from other neurological conditions is challenging, especially with incomplete patient history.
Observation:
- This report details an unusual case of paralytic rabies with descending paralysis, later progressing to the furious form.
- Magnetic Resonance Imaging (MRI) provided key diagnostic clues in this atypical presentation.
- Rabies myelitis is rare, and its MRI characteristics require further elucidation.
Findings:
- MRI findings in rabies myelitis were characterized and presented.
- The study discusses the differential diagnosis of the observed imaging findings.
- The relevance and role of imaging in diagnosing rabies, particularly atypical forms, are explored.
Implications:
- This case underscores the importance of considering rabies in the differential diagnosis of paralytic neurological syndromes.
- MRI can be a valuable tool in identifying atypical rabies presentations, aiding prompt diagnosis and management.
- Further research into the neuroimaging features of rabies myelitis is warranted to improve diagnostic accuracy.
