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Pontine Tegmentum Lesions Accompanying Myelitis During an Enterovirus Outbreak: Differential Diagnosis and Outcome

Mehmet Bastemur1, Rahsan Gocmen2, Safak Parlak2

  • 1Department of Pediatric Neurology, Ihsan Doğramaci Children's Hospital, Faculty of Medicine, Hacettepe University, Ankara.

Journal of Child Neurology
|June 9, 2020
PubMed
Abstract

Insights

Pontine tegmentum lesions in acute flaccid myelitis can have various causes. While encephalitis often resolves well, spinal cord involvement frequently leads to lasting motor deficits, regardless of MRI findings.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Radiology

Background:

  • Acute flaccid myelitis (AFM) is a serious neurological condition.
  • Pontine tegmentum lesions are sometimes observed in AFM cases.
  • Understanding the causes and outcomes of these lesions is crucial for patient management.

Purpose of the Study:

  • To investigate the causes (etiology) of pontine tegmentum lesions in patients with acute flaccid myelitis.
  • To determine the prognostic significance of these lesions on patient outcomes.
  • To analyze clinical and imaging findings in a cohort of patients with AFM and pontine involvement.

Main Methods:

  • Retrospective study of 22 patients from 6 centers in Turkey.
  • Inclusion criteria: encephalitis or myelitis with dorsal pontine lesions on MRI between July 2018 and February 2019.
  • Etiological investigations included reverse transcription polymerase chain reaction (RT-PCR) for enterovirus.

Main Results:

  • Ten patients (45%) had acute paralysis; 12 (55%) had only brainstem symptoms.
  • Enterovirus was detected in 2 patients; other etiologies were found in 10 cases.
  • Spinal cord lesions resolved in 55% of myelitis cases, but motor sequelae were common. Encephalitis symptoms resolved in 76% with good brain MRI recovery.

Conclusions:

  • Diverse etiologic agents can cause pontine involvement in AFM, even during enterovirus D68 outbreaks.
  • Encephalitis generally has a fair outcome, but spinal involvement often results in slow recovery and frequent motor deficits.
  • Follow-up spinal MRI findings do not always correlate with long-term motor recovery in AFM.
Keywords:
acute flaccid myelitisenteroviruspediatricponstegmentum

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