Neonatal parechovirus leucoencephalitis- radiological pattern mimicking hypoxic-ischemic encephalopathy
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Updated: Mar 27, 2026
Early Pathological and Magnetic Resonance Detection of Cerebral Injury Using a Rat Model of Neonatal Hypoxic Ischemic Encephalopathy
Published on: October 28, 2022
C Amarnath1, T Helen Mary1, A Periakarupan2
1Department of Radiodiagnosis, Government Stanley Medical College, Chennai 600001, India.
Aim:
Our objective is to study the MR imaging pattern in neonatal parechoviral leucoencephalitis, a rare cause of neonatal white matter abnormality and to differentiate it from hypoxic-ischemic encephalopathy which is the commonest cause of white matter change in neonates.
Method:
We evaluated 25 neonates who presented with features of encephalopathy. Cranial ultrasound and MR imaging was done in all the cases. The pattern of white matter abnormality was analyzed in all cases.
Results:
Neonatal leucoencephalitis caused by HPeV has a distinctive clinical presentation and has predilection for the white matter, causing diffusion restricting signal intensity changes involving the periventricular and subcortical white matter, in particular the frontal white matter, also the corpus callosum, internal capsule, external capsule and pyramidal tracts of the supratentorial brain and cerebral peduncle with relative sparing of occipital white matter, thalamus, basal ganglia and the infratentorial regions. Follow up imaging shows disappearance of the lesion without white matter loss. Whereas mild to moderate hypoxic-ischemic injury in a full-term neonate causes lesions in the watershed areas, and subcortical white matter predominantly involving the parietooccipital region and perirolandic region. Thalamus, brainstem, cerebellum, and deep gray matter structures are involved depending on the severity.
Conclusion:
White matter changes in the neonatal period are commonly associated with hypoxic-ischemic injuries and metabolic causes, less frequently, infection like parechovirus leucoencephalitis. HPeV infection must be considered in infants with specific pattern of white matter change but no convincing history of a perinatal hypoxic-ischemic insult, thus differentiating it from HIE.
Insights
Parechovirus leucoencephalitis in neonates presents with distinct white matter changes on MR imaging, differing from hypoxic-ischemic encephalopathy. Recognizing this pattern aids in diagnosis and differentiation.
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.
