Enterovirus rhombencephalitis

Magnetic
resonance imaging patterns of paediatric brain infections: a pictorial review based on the Western Australian experience. Restricted diffusion in supratentorial white matter—limited (Pattern 1B). 8-day-old term infant with raised inflammatory markers and vomiting (no seizures). CSF was positive for enterovirus. DWI (a–c) demonstrated scattered foci of restricted diffusion involving deep and periventricular white matter, best seen in the frontal lobes (a) and temporal lobes (c). On T2-weighted imaging (d), corresponding foci of low signal intensity were difficult to appreciate (arrows)
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Magnetic
resonance imaging patterns of paediatric brain infections: a pictorial review based on the Western Australian experience. T2 hyperintensity in posterior fossa—dorsal pons (Pattern 6A). Case 1: 4-year-old child with fluctuating GCS. Stool was positive for enterovirus (serotype E-71). T2-weighted imaging (a, b) demonstrated hyperintensity of the dorsal pons and medulla, with extension of signal abnormality into the middle cerebellar peduncles bilaterally (arrows). Case 2: 3-year-old child with lethargy, vomiting and fever, as well as right facial nerve palsy and unsteadiness on feet. Stool was positive for enterovirus (serotype not known). T2-weighted imaging (c, d) demonstrated hyperintensity of the dorsal pons and medulla, with extension of signal abnormality into the middle cerebellar peduncles bilaterally (arrows)
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MRI signal
intensity differentiation of brainstem encephalitis induced by Enterovirus 71: a classification approach for acute and convalescence stages. Schematic diagram depicting the location of primary lesion of brainstem encephalitis. The primary lesion is located at the posterior junction region of the pons and medulla oblongata. It is usually presented as an oval shaped fleck, which varies from 1 to 2.5 cm in length
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MRI signal
intensity differentiation of brainstem encephalitis induced by Enterovirus 71: a classification approach for acute and convalescence stages. T1WI and T2WI MRI scans of diseased and healthy subjects. a. Acute stage: Sagittal MR images revealed a longitudinal lesion at the posterior junction region of the pons and medulla oblongata, with prolonged T1 (a, white arrow) and prolonged T2 (b, black arrow) signal. b Convalescence stage: MR images showed there was a longitudinal malacia cavity at the posterior junction region of the pons and medulla, with prolonged T1 (a, white arrow) and prolonged T1 (b, black arrow) signal. c) Healthy controls: plain MRI scan show there is no abnormality
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Enterovirus rhombencephalitis is the most common neurological complication of enterovirus infection .

Clinical presentation

Enterovirus rhombencephalitis causes acute and severe neurologic disorders such as ataxia, nystagmus, oculomotor palsies, or bulbar palsy. In some cases, neurologic affection can extend to the spinal cord .

EV71 brainstem encephalitis occasionally induces autonomic dysfunction, such as fluctuating blood pressure and pulmonary hemorrhage/edema leading to death.

Diagnosis usually made by neuroimaging findings in conjunction with virus isolation from at least one site (e.g. throat swab, stool, CSF).

Radiographic features

MRI

Brainstem is the most common site of involvement. High signal intensities may be seen on T2-weighted and fluid-attenuated inversion recovery images in the dorsal aspect of the pons, medulla, midbrain, and dentate nuclei . The dorsal aspect of the pons (pontine tegmentum) is the most common site of brainstem involvement . Ventral pontine lesions, substantia nigra and dentate nuclei affection can also be found, but there is usually no supratentorial involvement.

Spinal cord signal anomalies can also be identified, with the cervical cord being the most commonly involved. In these cases, there is increased T2 signal throughout the entire spinal cord grey matter.

Differential diagnosis

Possible differential considerations include

Siehe auch:
Assoziationen und Differentialdiagnosen zu Enterovirusenzephalitis:
Virusenzephalitis
 
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pädiatrische
zerebrale Infektionen
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Humanes
Parechovirus Meningoenzephalitis
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