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Enterovirus-related rhombencephalitis and myelitis in the third trimester of pregnancy: A case report highlighting clinico-radiological findings at diagnosis and follow-up.
Radiol Case Rep. 2020 Aug; 15(8):1323-1330.RC

Abstract

Rhombencephalitis (RE) refers to inflammatory diseases involving the brainstem and cerebellum. Although RE is a rare entity, it is associated with high morbidity and mortality. The management of such patients is often challenging in terms of identifying the etiology and defining prognosis. Infections, autoimmune and paraneoplastic conditions are commonly implicated. Patients with RE often present with a biphasic illness with an initial flu-like syndrome followed by brainstem dysfunction. CSF pleocytosis, abnormal brain MRI findings, isolation of organism or molecular (PCR/antigen) detection in CSF/blood cultures/stool samples and nasal/rectal swabs help in arriving at a definitive or probable diagnosis. Prompt aggressive treatment with antibacterial and antiviral drugs and/or immunoglobulins along with supportive therapy is crucial for avoiding a poor outcome. We present a case report of a 28-year old female patient who developed RE and myelitis in the third trimester of pregnancy. We aim to highlight the highly suggestive radiological findings which corroborated with the clinical diagnosis of enterovirus infection. The patient's radiological follow-up and neurological sequalae are also described. To the best of our knowledge, ours is the first report which describes the MRI features of this clinical scenario in the third trimester of pregnancy, and also the subsequent clinico-radiological follow up.

Authors+Show Affiliations

Dept. of Neurology, National Neuroscience Institute, 11 Jln Tan Tock Seng, 308433, Singapore.Dept. of Internal medicine, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, 308433, Singapore.Dept. of Neurology, National Neuroscience Institute, 11 Jln Tan Tock Seng, 308433, Singapore.Dept. of Neuroradiology, National Neuroscience Institute, 11 Jln Tan Tock Seng, 308433, Singapore.Dept. of Neuroradiology, National Neuroscience Institute, 11 Jln Tan Tock Seng, 308433, Singapore.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

32612733

Citation

Sonu, Sumit Kumar, et al. "Enterovirus-related Rhombencephalitis and Myelitis in the Third Trimester of Pregnancy: a Case Report Highlighting Clinico-radiological Findings at Diagnosis and Follow-up." Radiology Case Reports, vol. 15, no. 8, 2020, pp. 1323-1330.
Sonu SK, Lai YW, Verma K, et al. Enterovirus-related rhombencephalitis and myelitis in the third trimester of pregnancy: A case report highlighting clinico-radiological findings at diagnosis and follow-up. Radiol Case Rep. 2020;15(8):1323-1330.
Sonu, S. K., Lai, Y. W., Verma, K., Sitoh, Y. Y., & Purohit, B. (2020). Enterovirus-related rhombencephalitis and myelitis in the third trimester of pregnancy: A case report highlighting clinico-radiological findings at diagnosis and follow-up. Radiology Case Reports, 15(8), 1323-1330. https://doi.org/10.1016/j.radcr.2020.05.062
Sonu SK, et al. Enterovirus-related Rhombencephalitis and Myelitis in the Third Trimester of Pregnancy: a Case Report Highlighting Clinico-radiological Findings at Diagnosis and Follow-up. Radiol Case Rep. 2020;15(8):1323-1330. PubMed PMID: 32612733.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Enterovirus-related rhombencephalitis and myelitis in the third trimester of pregnancy: A case report highlighting clinico-radiological findings at diagnosis and follow-up. AU - Sonu,Sumit Kumar, AU - Lai,Yi Wye, AU - Verma,Kamal, AU - Sitoh,Yih Yian, AU - Purohit,Bela, Y1 - 2020/06/23/ PY - 2020/05/17/received PY - 2020/05/27/revised PY - 2020/05/27/accepted PY - 2020/7/3/entrez PY - 2020/7/3/pubmed PY - 2020/7/3/medline KW - Anterior-horn cells KW - Brainstem KW - Enterovirus KW - Myelitis KW - Pregnancy KW - Rhombencephalitis SP - 1323 EP - 1330 JF - Radiology case reports JO - Radiol Case Rep VL - 15 IS - 8 N2 - Rhombencephalitis (RE) refers to inflammatory diseases involving the brainstem and cerebellum. Although RE is a rare entity, it is associated with high morbidity and mortality. The management of such patients is often challenging in terms of identifying the etiology and defining prognosis. Infections, autoimmune and paraneoplastic conditions are commonly implicated. Patients with RE often present with a biphasic illness with an initial flu-like syndrome followed by brainstem dysfunction. CSF pleocytosis, abnormal brain MRI findings, isolation of organism or molecular (PCR/antigen) detection in CSF/blood cultures/stool samples and nasal/rectal swabs help in arriving at a definitive or probable diagnosis. Prompt aggressive treatment with antibacterial and antiviral drugs and/or immunoglobulins along with supportive therapy is crucial for avoiding a poor outcome. We present a case report of a 28-year old female patient who developed RE and myelitis in the third trimester of pregnancy. We aim to highlight the highly suggestive radiological findings which corroborated with the clinical diagnosis of enterovirus infection. The patient's radiological follow-up and neurological sequalae are also described. To the best of our knowledge, ours is the first report which describes the MRI features of this clinical scenario in the third trimester of pregnancy, and also the subsequent clinico-radiological follow up. SN - 1930-0433 UR - https://www.unboundmedicine.com/medline/citation/32612733/Enterovirus-related_rhombencephalitis_and_myelitis_in_the_third_trimester_of_pregnancy:_A_case_report_highlighting_clinico-radiological_findings_at_diagnosis_and_follow-up L2 - https://linkinghub.elsevier.com/retrieve/pii/S1930-0433(20)30237-5 DB - PRIME DP - Unbound Medicine ER -
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