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Published on: November 13, 2016
Post-mumps encephalitis mimicking metabolic disease on brain magnetic resonance imaging: a case report
Amine Ben Lakhal1,2, Meriem Ben Hafsa3,4, Hanene Benrhouma3,4
1Research Laboratory LR18SP04 and Neuroradiology Department, National Institute Mongi Ben Hmida of Neurology, Av. de la Rabta, Tunis, 1007, Tunisia. amine.ben.lakhal@outlook.com.
Abstract:
Post-infectious encephalitis is a rare manifestation of mumps. We report the case of an 11-year-old boy who presented with pseudobulbar syndrome and parkinsonism, 1 week following mumps parotitis. Magnetic resonance imaging of the brain showed bilateral and symmetric changes in the basal ganglia with signal abnormalities in the white matter surrounding the lentiform nuclei. Lumbar puncture confirmed the presence of mumps antibodies in the cerebrospinal fluid, confirming the diagnosis of post-mumps encephalitis. Symmetric basal ganglia involvement has been described in mumps encephalitis. However, to our knowledge, this is the first reported case with basal ganglia lesions surrounded by white matter abnormalities, the so-called lentiform fork sign, commonly found in cases of metabolic acidosis.
Insights
Post-infectious encephalitis following mumps is rare. This case highlights a unique presentation in an 11-year-old boy with parkinsonism and a distinctive MRI finding, the lentiform fork sign.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Post-infectious encephalitis is a rare complication of mumps virus infection.
- Neurological manifestations of mumps can vary widely.
- Early diagnosis and understanding of imaging findings are crucial for patient management.
Purpose of the Study:
- To report a unique case of post-mumps encephalitis in a child.
- To describe the clinical and neuroimaging findings, including a rare MRI sign.
- To contribute to the understanding of mumps encephalitis presentations.
Main Methods:
- Case report of an 11-year-old boy with symptoms following mumps.
- Clinical assessment including neurological examination.
- Brain Magnetic Resonance Imaging (MRI) for evaluating brain lesions.
- Cerebrospinal fluid (CSF) analysis for mumps antibodies.
Main Results:
- The patient presented with pseudobulbar syndrome and parkinsonism one week after mumps parotitis.
- Brain MRI revealed bilateral, symmetric basal ganglia lesions with surrounding white matter abnormalities (lentiform fork sign).
- CSF analysis confirmed the presence of mumps antibodies, diagnosing post-mumps encephalitis.
Conclusions:
- This case represents the first reported instance of post-mumps encephalitis presenting with the lentiform fork sign.
- The findings emphasize the diverse neurological sequelae of mumps infection.
- The lentiform fork sign, typically associated with metabolic disorders, was observed in this infectious encephalitis case, expanding its differential diagnosis.
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