Pediatric viral encephalitis - Guide for diagnosing typical and atypical cases

Congress:

ECR 2020

Poster Number:

C-11147

Type:

Educational Exhibit

Keywords:

Not applicable, Infection, Imaging sequences, MR-Diffusion/Perfusion, MR, Paediatric, Neuroradiology brain, CNS, Neuro

Authors:

J. Rajasekaran, K. Gopinathan, P. D. J. Devimeenal, D. K. GEETHA, S. Nagarajan; Chennai/IN

DOI:

10.26044/ecr2020/C-11147

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-11147

Fig. 1: Learning objectives

Fig. 2: Viral encephalitis - common causes

Fig. 3: Common sites of predilection

Fig. 4: Common sites of predilection

Learning objectives

This article highlights the common causes, imaging features and pathogenesis of viral encephalitis.

Background

Infectious diseases continue to be a major cause of mortality and morbidity in developing countries despite our efforts to control them. Among the infectious agents, viruses remain the most common cause of CNS infection, particularly in paediatric population. Viruses are obligate intracellular pathogens which gain access to the CNS through hematogenous (e.g. arbovirus), neurogenic (e.g. rabies, herpes virus) and respiratory (e.g. influenza) routes. Most cases of viral encephalitis are managed by symptomatic treatment and prompt supportive care. But antiviral therapy can be lifesaving in certain...

Findings and procedure details

MRI is the most useful imaging tool in diagnosing viral encephalitis. We used conventional sequences like T1WI, T2WI, FLAIR and DWI in all cases. DWI showed changes even during the early phase of illness. Hypointense changes on T1WI and hyperintense T2/ FLAIR changes appeared later in the disease course. T2* sequences were used to identify haemorrhage. Post contrast T1WI (T1W C+) showed no/minimal enhancement. MRS, MTR & DTI were used in selected cases. For evaluating calcifications, CT was more helpful than MRI. JAPANESE ENCEPHALITIS: JE...

Conclusion

Most cases of viral encephalitis have nonspecific imaging findings, however few of them show characteristic patterns of involvement. Though molecular and serological assays are highly sensitive and specific, their availability and cost are the limitations. Radiologists should attempt to identify the specific etiological agent, which helps in better patient management.

Personal information and conflict of interest

Dr. Janani Rajasekaran Junior Resident, Department of Radiology, Govt Kilpauk Medical College, Chennai, Tamil Nadu, India. Email: [email protected] Prof. Dr. K. Gopinathan Govt Royapettah Hospital, Chennai. Dr. J. Devimeenal Professor & HOD, Govt Kilpauk Medical College. Dr.K.Geetha Associate Professor of Radiology. Dr. Suriyaprakash Nagarajan Junior Resident.

References

Diagnostic imaging pediatric neuroradiology. Imaging in pediatrics by Merrow & Hariharan. Amarnath, C., et al. "Neonatal Parechovirus leucoencephalitis-radiological pattern mimicking hypoxic-ischemic encephalopathy." Mehta, Ravi, et al. "The neurological complications of chikungunya virus: a systematic review." Jugpal, Tejeshwar Singh, et al. "Spectrum of findings on magnetic resonance imaging of the brain in patients with neurological manifestations of dengue fever."