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MRI findings in children with acute flaccid paralysis and cranial nerve dysfunction occurring during the 2014

J A Maloney1, D M Mirsky2, K Messacar3

  • 1From the Departments of Radiology (J.A.M., D.M.M., N.V.S.) john.maloney@childrenscolorado.org.

AJNR. American Journal of Neuroradiology
|November 22, 2014
PubMed
Abstract

Insights

Enterovirus D68 outbreaks in 2014 caused acute flaccid paralysis. Unique brain stem and spinal cord MRI findings were observed in affected patients during this enterovirus D68 outbreak.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Radiology

Background:

  • Enterovirus D68 (EV-D68) caused widespread respiratory illness outbreaks in the US in 2014.
  • A concurrent rise in acute flaccid paralysis (AFP) and cranial nerve dysfunction was noted.
  • The specific neurological manifestations and imaging characteristics of EV-D68 associated AFP were not well-defined.

Purpose of the Study:

  • To describe the unique neuroimaging findings in patients with acute flaccid paralysis and cranial nerve dysfunction during the 2014 enterovirus D68 outbreak.
  • To correlate clinical presentation with specific magnetic resonance imaging (MRI) abnormalities.
  • To differentiate EV-D68 associated neurological syndromes from other causes of myelitis.

Main Methods:

  • Retrospective review of patients meeting case definition for AFP and/or cranial nerve dysfunction during the EV-D68 outbreak.
  • Inclusion criteria: presentation to the institution during the study period and specific neurological symptoms.
  • All-inclusive MR imaging of the brain and/or spinal cord, including T1, T2, and contrast-enhanced T1-weighted sequences.

Main Results:

  • Eleven patients met inclusion criteria for MR imaging.
  • Nine patients exhibited brain stem lesions, predominantly in the pontine tegmentum.
  • Ten patients had longitudinally extensive spinal cord lesions, initially involving central gray matter and later anterior horn cells; nerve root enhancement was observed in the subacute phase.

Conclusions:

  • Patients with AFP and cranial nerve dysfunction during the EV-D68 outbreak showed distinct neuroimaging patterns.
  • Characteristic findings include brain stem and spinal cord gray matter lesions.
  • These findings resemble those seen in other viral myelitis outbreaks, such as enterovirus 71 and poliomyelitis.

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