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Published on: July 24, 2016
Disseminated cortical and subcortical lesions in neonatal enterovirus 71 encephalitis
Ryoko Nakamura1, Pin Fee Chong2, Kohei Haraguchi1
1Department of Pediatric Neurology, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha Higashi-ku, Fukuoka, 813-0017, Japan.
Abstract:
Enteroviruses are one of the most important causes of viral encephalitis in the neonatal period. However, the non-specificity of the symptoms presented renders its diagnosis challenging. Intracranial MRI has been reported to be a very useful imaging modality that can detect the characteristic white matter lesions around the periventricular regions. In this study, we report a case of a patient with neonatal encephalitis who presented with normal white blood cell counts in the initial cerebrospinal fluid analysis. A lumbar puncture retap identified pleocytosis, and polymerase chain reaction assays detected enterovirus 71 in the blood and stool samples. Furthermore, MRI revealed atypical disseminated cortical and subcortical white matter lesions on diffusion weighted images, and neuroradiological re-evaluation showed necrotic changes 2 weeks later. This unique case expands our knowledge of the spectrum of neurological disorders due to enterovirus 71 infection in neonatal period.
Insights
Neonatal encephalitis caused by enterovirus 71 can present atypically. This case highlights unusual MRI findings and delayed diagnosis challenges in newborns with enterovirus 71 infection.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Enteroviruses are a significant cause of viral encephalitis in neonates, often presenting with non-specific symptoms.
- Diagnosis can be challenging due to subtle initial clinical signs and normal cerebrospinal fluid findings.
- Intracranial MRI is valuable for detecting characteristic periventricular white matter lesions.
Observation:
- A case of neonatal encephalitis with initially normal cerebrospinal fluid white blood cell counts is presented.
- Subsequent lumbar puncture revealed pleocytosis, and PCR confirmed enterovirus 71 in blood and stool.
- Initial MRI showed atypical disseminated cortical and subcortical white matter lesions.
Findings:
- Diffusion-weighted MRI revealed disseminated white matter lesions.
- Follow-up imaging demonstrated necrotic changes, indicating disease progression.
- Enterovirus 71 was identified as the causative agent through molecular assays.
Implications:
- This case expands the understanding of neurological manifestations of enterovirus 71 in neonates.
- It emphasizes the importance of considering atypical presentations and advanced imaging in diagnosing neonatal encephalitis.
- Early and accurate diagnosis is crucial for managing enterovirus 71 infections and improving outcomes.
