Neonatal parechovirus leucoencephalitis- radiological pattern mimicking hypoxic-ischemic encephalopathy

Area of Science:

• Neonatal neurology
• Pediatric radiology
• Infectious diseases

Background:

• Neonatal white matter abnormalities are common, often linked to hypoxic-ischemic encephalopathy (HIE).
• Parechovirus leucoencephalitis (HPeV) is a rare but significant cause of neonatal white matter injury.
• Differentiating HPeV from HIE is crucial for appropriate management.

Purpose of the Study:

• To characterize the MR imaging patterns of neonatal parechovirus leucoencephalitis.
• To distinguish HPeV-induced white matter changes from those seen in HIE.
• To improve diagnostic accuracy in neonates with white matter abnormalities.

Main Methods:

• Retrospective analysis of 25 neonates with encephalopathy.
• Evaluation of cranial ultrasound and MR imaging findings.
• Detailed assessment of white matter abnormality patterns.

Main Results:

• HPeV leucoencephalitis shows characteristic diffusion-restricting lesions in periventricular, subcortical, frontal white matter, corpus callosum, internal/external capsules, and cerebral peduncles.
• HIE typically affects watershed areas and parietooccipital/perirolandic subcortical white matter, with variable involvement of deep gray matter and infratentorial structures.
• Follow-up MR imaging in HPeV cases revealed lesion resolution without white matter loss.

Conclusions:

• Neonatal white matter changes are frequently due to HIE or metabolic causes, with HPeV infection being less common.
• A specific MR imaging pattern of white matter abnormality in neonates without a clear history of hypoxic-ischemic insult should raise suspicion for HPeV infection.
• Distinguishing HPeV leucoencephalitis from HIE based on characteristic imaging findings is essential for accurate diagnosis.