Related Experiment Videos
Serial magnetic resonance imaging in children with postinfectious encephalitis
1Yokohama City University, Urafune Hospital, Department of Pediatrics, Kanagawa, Japan.
Abstract:
We analyzed follow-up magnetic resonance images (MRI) in eight children with clinical postinfectious encephalitis (PIE), and discussed their pathogeneses. Three categories of MRI findings were apparent: (1) multifocal lesions in the white matter with/without basal ganglia involvement consistent with acute disseminated encephalomyelitis (ADEM) (three patients); (2) single or multifocal lesions localized only in the gray matter (two patients); and (3) localized lesions in the brain stem, basal ganglia or cerebellum. Some lesions in the patients in Categories 1 and 2 migrated or were resolved quickly, sometimes within 10 days. Gadolinium caused linear or spotty enhancement in the patients in Category 2. These findings suggest that Categories 1 and 2 are a self-limiting allergic angiopathy without demyelination. In contrast, the lesions in the patients in Category 3 were fixed, and not resolved within 6 months (three patients). The pathogenesis of Category 3 is not known. All except one patient had no prednisolone (PSL) therapy, however; all lesions were resolved completely or markedly reduced in size, which indicates PSL therapy is not always necessary in patients with PIE.
Insights
Postinfectious encephalitis (PIE) in children can present with distinct MRI patterns. Some forms may resolve spontaneously, suggesting steroid therapy is not always necessary.
Area of Science:
- Neurology
- Pediatric Neurology
- Neuroradiology
Background:
- Postinfectious encephalitis (PIE) is an inflammatory brain condition in children.
- Understanding the imaging patterns and pathogenesis of PIE is crucial for effective management.
Observation:
- Follow-up MRI scans of eight children with PIE were analyzed.
- Three distinct MRI finding categories were identified: ADEM-like white matter lesions, gray matter-only lesions, and fixed brainstem/basal ganglia/cerebellar lesions.
- Rapid lesion resolution and migration were observed in the first two categories, with enhancement after gadolinium contrast in the gray matter group.
Findings:
- Categories 1 and 2 suggest a self-limiting allergic angiopathy without demyelination.
- Category 3 lesions were persistent, with unknown pathogenesis.
- Most patients did not receive prednisolone (PSL) therapy, yet showed complete or marked lesion resolution.
Implications:
- MRI findings can help differentiate PIE subtypes.
- The self-limiting nature of some PIE forms suggests prednisolone may not always be required.
- Further research is needed to elucidate the pathogenesis of persistent PIE lesions.