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Leptomeningeal Enhancement without Thalamic Involvement as an Initial Manifestation of Japanese Encephalitis: A Case
Abstract:
Japanese encephalitis (JE) is a common infection caused by the Japanese encephalitis virus in Southeast Asia, which is transmitted to humans through Culex mosquitoes. Magnetic resonance imaging (MRI) is used to diagnose JE, which is often characterized by the presence of bilateral symmetric thalamic involvement. Here, we report a rare case of JE characterized by leptomeningeal enhancement without thalamic involvement. This leptomeningeal enhancement disappeared with the treatment; however, new non-specific multifocal and bilateral high signal intensities in the cerebral white matter were found on follow-up MRI.
Insights
Japanese encephalitis (JE) is a mosquito-borne viral infection. This rare case highlights unusual MRI findings, including leptomeningeal enhancement without thalamic involvement, offering new insights into JE diagnosis.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Japanese encephalitis (JE) is a prevalent mosquito-borne viral illness in Southeast Asia.
- Diagnosis often relies on Magnetic Resonance Imaging (MRI) revealing characteristic bilateral symmetric thalamic lesions.
Observation:
- This report details an uncommon JE case presenting with leptomeningeal enhancement.
- Crucially, this case lacked the typical thalamic involvement seen in standard JE presentations.
Findings:
- Leptomeningeal enhancement resolved following treatment.
- Follow-up MRI revealed new, non-specific multifocal bilateral white matter lesions.
Implications:
- This case expands the spectrum of MRI findings in Japanese encephalitis.
- It underscores the importance of considering atypical presentations for accurate JE diagnosis and management.
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