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Enterovirus 71-related encephalomyelitis: usual and unusual magnetic resonance imaging findings.
Neuroradiology. 2012 Mar; 54(3):239-45.N

Abstract

INTRODUCTION

Most enterovirus (EV) 71 infections manifest as mild cases of hand-foot-mouth disease (HFMD)/herpangina with seasonal variations, having peak incidence during the summer. Meanwhile, EV 71 may involve the central nervous system (CNS), causing severe neurologic disease. In many cases, enteroviral encephalomyelitis involves the central midbrain, posterior portion of the medulla oblongata and pons, bilateral dentate nuclei of the cerebellum, and the ventral roots of the cervical spinal cord, and the lesions show hyperintensity on T2-weighted and fluid-attenuation inversion recovery (FLAIR) images. Our goal was to review usual and unusual magnetic resonance (MR) findings in CNS involvement of enteroviral infection.

METHODS

Among consecutive patients who had HFMD and clinically suspected encephalitis or myelitis and who underwent brain or spinal MR imaging, five patients revealed abnormal MR findings. Diffusion-weighted and conventional MR and follow-up MR images were obtained. From cerebrospinal fluid, stool, or nasopharyngeal swabs, EV 71 was confirmed in all patients.

RESULTS

MR imaging studies of two patients showed hyperintensity in the posterior portion of the brainstem on T2-weighted and FLAIR images, which is the well-known MR finding of EV 71 encephalitis. The remaining three cases revealed unusual manifestations: leptomeningeal enhancement, abnormal enhancement along the ventral roots at the conus medullaris level without brain involvement, and hyperintensity in the left hippocampus on T2/FLAIR images.

CONCLUSION

EV 71 encephalomyelitis shows relatively characteristic MR findings; therefore, imaging can be helpful in radiologic diagnosis. However, physicians should also be aware of unusual radiologic manifestations of EV 71.

Authors+Show Affiliations

Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 97 Gurodong, Guro-gu, Seoul, 152-703, South Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

21861081

Citation

Jang, Seonah, et al. "Enterovirus 71-related Encephalomyelitis: Usual and Unusual Magnetic Resonance Imaging Findings." Neuroradiology, vol. 54, no. 3, 2012, pp. 239-45.
Jang S, Suh SI, Ha SM, et al. Enterovirus 71-related encephalomyelitis: usual and unusual magnetic resonance imaging findings. Neuroradiology. 2012;54(3):239-45.
Jang, S., Suh, S. I., Ha, S. M., Byeon, J. H., Eun, B. L., Lee, Y. H., Seo, H. S., Eun, S. H., & Seol, H. Y. (2012). Enterovirus 71-related encephalomyelitis: usual and unusual magnetic resonance imaging findings. Neuroradiology, 54(3), 239-45. https://doi.org/10.1007/s00234-011-0921-8
Jang S, et al. Enterovirus 71-related Encephalomyelitis: Usual and Unusual Magnetic Resonance Imaging Findings. Neuroradiology. 2012;54(3):239-45. PubMed PMID: 21861081.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Enterovirus 71-related encephalomyelitis: usual and unusual magnetic resonance imaging findings. AU - Jang,Seonah, AU - Suh,Sang-il, AU - Ha,Su Min, AU - Byeon,Jung Hye, AU - Eun,Baik-Lin, AU - Lee,Young Hen, AU - Seo,Hyung Suk, AU - Eun,So-Hee, AU - Seol,Hae-Young, Y1 - 2011/08/24/ PY - 2011/05/02/received PY - 2011/07/15/accepted PY - 2011/8/24/entrez PY - 2011/8/24/pubmed PY - 2012/6/20/medline SP - 239 EP - 45 JF - Neuroradiology JO - Neuroradiology VL - 54 IS - 3 N2 - INTRODUCTION: Most enterovirus (EV) 71 infections manifest as mild cases of hand-foot-mouth disease (HFMD)/herpangina with seasonal variations, having peak incidence during the summer. Meanwhile, EV 71 may involve the central nervous system (CNS), causing severe neurologic disease. In many cases, enteroviral encephalomyelitis involves the central midbrain, posterior portion of the medulla oblongata and pons, bilateral dentate nuclei of the cerebellum, and the ventral roots of the cervical spinal cord, and the lesions show hyperintensity on T2-weighted and fluid-attenuation inversion recovery (FLAIR) images. Our goal was to review usual and unusual magnetic resonance (MR) findings in CNS involvement of enteroviral infection. METHODS: Among consecutive patients who had HFMD and clinically suspected encephalitis or myelitis and who underwent brain or spinal MR imaging, five patients revealed abnormal MR findings. Diffusion-weighted and conventional MR and follow-up MR images were obtained. From cerebrospinal fluid, stool, or nasopharyngeal swabs, EV 71 was confirmed in all patients. RESULTS: MR imaging studies of two patients showed hyperintensity in the posterior portion of the brainstem on T2-weighted and FLAIR images, which is the well-known MR finding of EV 71 encephalitis. The remaining three cases revealed unusual manifestations: leptomeningeal enhancement, abnormal enhancement along the ventral roots at the conus medullaris level without brain involvement, and hyperintensity in the left hippocampus on T2/FLAIR images. CONCLUSION: EV 71 encephalomyelitis shows relatively characteristic MR findings; therefore, imaging can be helpful in radiologic diagnosis. However, physicians should also be aware of unusual radiologic manifestations of EV 71. SN - 1432-1920 UR - https://www.unboundmedicine.com/medline/citation/21861081/Enterovirus_71_related_encephalomyelitis:_usual_and_unusual_magnetic_resonance_imaging_findings_ L2 - https://dx.doi.org/10.1007/s00234-011-0921-8 DB - PRIME DP - Unbound Medicine ER -