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Brain MRI in Epstein-Barr Virus Meningoencephalitis in Children
Sameer Vyas1, Renu Suthar2, Vikas Bhatia1
1Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Background And Purpose:
Epstein-Barr virus (EBV) meningoencephalitis can have variable and nonspecific brain magnetic resonance imaging (MRI) findings in children. This study was done with the purpose of describing brain MRI findings in children with EBV meningoencephalitis.
Materials And Methods:
The study included 45 pediatric patients that presented with variable neurological symptoms and were found to have EBV meningoencephalitis based on positive EBV deoxyribonucleic acid (DNA) in the cerebrospinal fluid. All these patients had undergone brain MRI. Clinical and radiological features were evaluated.
Results:
Fever was a presenting feature in all cases. Signs of meningitis and raised intracranial pressure (ICP) were seen in 24 (53.3%) cases, encephalopathy in 15 (33.3%), and seizures were present in 33 (73.3%). MRI was abnormal in 29 (64.4%) patients. The cortical/subcortical pattern was diagnosed in 9 (20%) cases, white matter involvement in 7 (15.5%), basal ganglia in 5 (11.1%), thalamic involvement in 4 (8.8%), brain stem involvement in 2 (6.2%), substantia nigra involvement in 2 (4.4%), and cerebellar involvement in 2 (4.4%). Diffusion restriction was present in 11 (24.4%) cases and susceptibility changes in 7 (15.5%). Meningeal enhancement was present in 10 (22.2%) cases. In addition, brain abscess and subdural effusion/empyema were present in 1 (2.2%) case each.
Conclusion:
Pediatric EBV meningoencephalitis has varied clinicoradiological spectrum and there is no specific MRI pattern to characterize the meningoencephalitis on imaging. Common MRI findings include cortical-subcortical involvement, white matter changes, basal ganglia, and thalamic involvement.
Insights
Brain MRI findings in pediatric Epstein-Barr virus (EBV) meningoencephalitis are variable. Common findings include cortical-subcortical, white matter, basal ganglia, and thalamic involvement, but no specific pattern exists.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Infectious Diseases
Background:
- Epstein-Barr virus (EBV) meningoencephalitis presents with diverse neurological symptoms in children.
- Brain magnetic resonance imaging (MRI) findings in pediatric EBV meningoencephalitis are often nonspecific and variable.
Purpose of the Study:
- To describe the spectrum of brain MRI findings in children diagnosed with EBV meningoencephalitis.
- To correlate clinical and radiological features in pediatric EBV meningoencephalitis.
Main Methods:
- Retrospective analysis of 45 pediatric patients with confirmed EBV meningoencephalitis (positive EBV DNA in cerebrospinal fluid).
- Evaluation of clinical presentations, including fever, meningitis signs, raised intracranial pressure, encephalopathy, and seizures.
- Detailed assessment of brain MRI findings, including patterns of involvement and specific changes like diffusion restriction and meningeal enhancement.
Main Results:
- Fever was universal; meningitis, raised intracranial pressure, encephalopathy, and seizures were common clinical features.
- MRI abnormalities were observed in 64.4% of patients.
- Frequent MRI findings included cortical-subcortical (20%), white matter (15.5%), basal ganglia (11.1%), and thalamic (8.8%) involvement. Diffusion restriction (24.4%) and meningeal enhancement (22.2%) were also noted.
Conclusions:
- Pediatric EBV meningoencephalitis exhibits a broad clinicoradiological spectrum.
- No single MRI pattern definitively characterizes EBV meningoencephalitis in children.
- Cortical-subcortical, white matter, basal ganglia, and thalamic involvement are common, but variable, MRI findings.
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