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Infantile encephalitic beriberi: magnetic resonance imaging findings
Nisar A Wani1, Umar A Qureshi2, Majid Jehangir3
1Department of Pediatric Radiology, Government Medical College Srinagar, Jammu and Kashmir, Pin, 190010, India. ahmad77chinar@gmail.com.
Insights
Infantile encephalitic beriberi, a thiamine deficiency, presents with specific brain MRI findings. Symmetrical basal ganglia lesions, restricted diffusion, and lactate peaks aid early diagnosis in at-risk infants.
Area of Science:
- Neurology
- Pediatrics
- Radiology
Background:
- Thiamine deficiency remains a concern in developing nations, potentially causing infantile encephalitic beriberi.
- This condition can manifest with severe acute neurological symptoms in infants.
Purpose of the Study:
- To review and document brain Magnetic Resonance Imaging (MRI) findings in infantile encephalitic beriberi.
- The study focuses on data from a single institution to understand characteristic MRI signatures.
Main Methods:
- A retrospective analysis of MRI scans was performed.
- The study included 22 infants diagnosed with acute-onset beriberi encephalopathy.
Main Results:
- All infants showed symmetrical T2-weighted hyperintense lesions in the putamen.
- Additional affected areas included the caudate nuclei (73%), thalami (32%), and cerebral cortex (32%).
- Restricted diffusion was observed in 64% of cases, and 75% exhibited elevated lactate peaks on MR spectroscopy.
Conclusions:
- Symmetrical T2-weighted hyperintensities in the basal ganglia are key MRI findings.
- The presence of restricted diffusion and a prominent lactate peak on MR spectroscopy can facilitate early diagnosis.
- Prompt recognition of these MRI features is crucial for timely intervention in at-risk infants.
Background:
Thiamine deficiency in infants is still encountered in developing countries. It may present with acute neurological manifestations of infantile encephalitic beriberi.
Objective:
To review brain MRI findings in infantile encephalitic beriberi from a single institution.
Materials And Methods:
A retrospective review of MRI scans in 22 infants with acute-onset beriberi encephalopathy was carried out.
Results:
Hyperintense lesions on T2-weighted images were seen symmetrically in the putamen in all patients, in the caudate nuclei in 16/22 (73%), the thalami in 7/22 (32%) and the globi pallidi in 3/22 (14%) of the infants. Altered signal intensity lesions in the cerebral cortex were seen in 7/22 (32%). The mammillary bodies were seen in one infant and the periaqueductal gray matter in two. There was restricted diffusion in 14/22 (64%), and 6/8 children with no evidence of restriction had been imaged ≥10 days after presentation. MR spectroscopy showed increased lactate peak in 6/8 infants (75%).
Conclusion:
Recognition of symmetrical T2-W hyperintense lesions in the basal ganglia with restricted diffusion and prominent lactate peak may allow early diagnosis of encephalitic beriberi in at-risk infants.
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