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Transient seizure-related MRI abnormalities in a child with primary Epstein-Barr virus infection
Tae Kamakura1, Akiyoshi Hiraki1, Masahiro Kikuchi1
1Department of Pediatrics, Hitachi General Hospital, Hitachi, Japan.
Insights
Infectious mononucleosis can cause temporary brain abnormalities on MRI, mimicking encephalitis. These seizure-related changes in children resolve quickly, aiding diagnosis.
Area of Science:
- Neurology
- Pediatrics
- Infectious Diseases
Background:
- Infectious mononucleosis, often caused by Epstein-Barr virus, can present with neurological complications.
- Encephalopathy and seizures are rare but serious manifestations requiring accurate diagnosis.
Observation:
- A 6-year-old girl with infectious mononucleosis developed hemiconvulsions and altered consciousness.
- Diffusion-weighted MRI revealed restricted diffusion in the left temporo-posterior cortex and thalamus.
- Neurological symptoms and MRI abnormalities resolved within 24 hours.
Findings:
- Elevated cerebrospinal fluid interleukin-6 (IL-6) levels were noted, with normal IL-10.
- MRI findings were attributed to seizure activity rather than Epstein-Barr virus encephalitis.
- Transient nature of MRI signal changes was a key observation.
Implications:
- Recognizing seizure-induced transient MRI abnormalities is crucial for diagnosing encephalopathy.
- This case highlights the importance of considering seizure activity in the differential diagnosis of MRI changes.
- Understanding these transient findings can prevent misdiagnosis and guide appropriate patient management.
Abstract:
We describe the case of a 6-year-old girl with typical infectious mononucleosis syndrome complicated by clustered right hemiconvulsions and disturbed consciousness. Diffusion-weighted magnetic resonance imaging on admission demonstrated reduced diffusion in the left temporo-posterior cortex and pulvinar of the ipsilateral thalamus. Her neurological symptoms resolved completely by the next day, with complete disappearance of abnormal signal intensities on magnetic resonance imaging (MRI). Elevated cerebrospinal fluid interleukin (IL)-6 with normal IL-10 might indicate a neuroprotective role of IL-6 rather than injury. We concluded that the MRI abnormalities could have been due to the seizure activity itself rather than Epstein-Barr virus-associated encephalitis. The recognition of transient seizure-related MRI abnormalities may help in the diagnostic approach to MRI changes in suspected encephalopathy.
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