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Pham TS, Montini F, Pham HN, Nguyen Tran MT, Huy NT, Cacciaguerra L, Filippi M. Radiological Features of Herpetic Encephalitis in Children. Pediatr Neurol 2024; 156:99-105. [PMID: 38744070 DOI: 10.1016/j.pediatrneurol.2024.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 02/02/2024] [Accepted: 03/31/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Nonspecific clinical manifestations and unclear radiological features may delay treatment initiation in pediatric patients with Herpes simplex encephalitis (HSE). The aim of this study is to analyze the clinical and radiological features of the disease. METHODS Clinical, laboratory, and magnetic resonance imaging (MRI) data were obtained retrospectively from a group of 37 hospitalized pediatric patients older than two months and with a polymerase chain reaction-confirmed HSE diagnosis. Clinical severity (i.e., mechanical ventilatory support) and outcome at discharge (i.e., pediatric modified Rankin Scale [ped-mRS]) were also assessed. RESULTS Median age was 14 months (interquartile range: 10-36). All patients survived, 15 (41%) had complete recovery (i.e., ped-mRS = 0), and 10 (27%) had significant residual disability at discharge (i.e., ped-mRS ≥3). Brain MRI was obtained in 31 patients. T2-hyperintense lesions were usually bilateral (28, 90%) and multifocal (30, 97%). Hemorrhage and mass effect were observed in 13 (42%) and 15 (48%) patients, respectively. Parenchymal lesions involved the temporal lobes (94%), insula (90%), parietal lobes (84%), and frontal lobes (61%). Occipital lesions were rare. In multivariable binary logistic regression models the presence of altered consciousness was associated with mechanical ventilation (odds ratio [OR] = 8.2, Nagelkerke R2 = 0.22), whereas the involvement of the occipital lobes (OR = 7.8) and the administration of vasopressors (OR = 12.1) were independent predictors of poor outcome (Nagelkerke R2 = 0.41). CONCLUSIONS Brain MRI is useful for diagnosis and outcome assessment in pediatric HSE. Radiological patterns with common frontotemporal involvement overlap adults, but multifocal and parietal lobe abnormalities are observed as well.
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Affiliation(s)
- Thai Son Pham
- Department of Covid-19, Children's Hospital 2, Ho Chi Minh, Vietnam
| | - Federico Montini
- Vita-Salute San Raffaele University, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Nguyen Tien Huy
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan; Institute of Research and Development, Duy Tan University, Da Nang, Vietnam; School of Medicine and Pharmacy, Duy Tan University, Da Nang, Vietnam
| | - Laura Cacciaguerra
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Massimo Filippi
- Vita-Salute San Raffaele University, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurorehabilitation Unit and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
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2
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Meena AK, Choudhary PK, Wander A, Madaan P. Atypical Neuroimaging Features of Herpes Simplex Virus-2 Encephalitis. Indian J Pediatr 2024:10.1007/s12098-024-05082-5. [PMID: 38393639 DOI: 10.1007/s12098-024-05082-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Affiliation(s)
- Ankit Kumar Meena
- Department of Pediatrics, ESIC Medical College & Hospital, Faridabad, Haryana, India.
| | | | - Arvinder Wander
- Department of Pediatrics, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Priyanka Madaan
- Department of Pediatric Neurology, Amrita School of Medicine, Faridabad, Haryana, India
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3
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Huff HV, Wilson-Murphy M. Neuroinfectious Diseases in Children: Pathophysiology, Outcomes, and Global Challenges. Pediatr Neurol 2024; 151:53-64. [PMID: 38103523 DOI: 10.1016/j.pediatrneurol.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/22/2023] [Accepted: 09/24/2023] [Indexed: 12/19/2023]
Abstract
Pathogens with affinity for the central nervous system (CNS) in children are diverse in their mechanisms of infecting and attacking the brain. Infections can reach the CNS via hematogenous routes, transneurally thereby avoiding the blood-brain barrier, and across mucosal or skin surfaces. Once transmission occurs, pathogens can wreak havoc both by direct action on host cells and via an intricate interplay between the protective and pathologic actions of the host's immune system. Pathogen prevalence varies depending on region, and susceptibility differs based on epidemiologic factors such as age, immune status, and genetics. In addition, some infectious diseases are monophasic, whereas others may lie dormant for years, thereby causing a dynamic effect on outcomes. Outcomes in survivors are highly variable for each particular pathogen and depend on the vaccination and immune status of the patient as well as the speed by which the patient receives evidence-based treatments. Given pathogens cause communicable diseases that can cause morbidity and mortality on a population level when spread, the burden is often the greatest and the outcomes the worst in low-resource settings. Here we will focus on the most common infections with a propensity to affect a child's brain, the pathologic mechanisms by which they do so, and what is known about the developmental outcomes in children who are affected by these infections.
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Affiliation(s)
- Hanalise V Huff
- Department of Neurology, National Institutes of Health, Bethesda, Maryland
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4
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Nunes RH, Corrêa DG, Pacheco FT, Fonseca APA, Hygino da Cruz LC, da Rocha AJ. Neuroimaging of Infectious Vasculopathy. Neuroimaging Clin N Am 2024; 34:93-111. [PMID: 37951708 DOI: 10.1016/j.nic.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Vasculitis is a complication of several infectious diseases affecting the central nervous system, which may result in ischemic and/or hemorrhagic stroke, transient ischemic attack, and aneurysm formation. Infectious agents may directly infect the endothelium causing vasculitis or indirectly affect the vessel wall through an immunological cascade. Clinical manifestations usually overlap with those of noninfectious vascular diseases, making diagnosis challenging. Neuroimaging enables the identification of inflammatory changes in intracranial vasculitis. In this article, we review the imaging features of infectious vasculitis of bacterial, viral, fungal and parasitic causes.
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Affiliation(s)
- Renato Hoffmann Nunes
- Division of Neuroradiology, DASA - Diagnósticos da América SA, Rua João Cachoeira, 743, Itaim Bibi, 04535-012, Sao Paulo, Sao Paulo, Brazil.
| | - Diogo Goulart Corrêa
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Avenida das Américas, 4666, Barra da Tijuca, 2640-102, Rio de Janeiro, Rio de Janeiro, Brazil; Department of Radiology, Federal Fluminense University, Avenida Marquês de Paraná, 303, 24033-900, Niterói, Rio de Janeiro, Brazil
| | - Felipe Torres Pacheco
- Division of Neuroradiology, DASA - Diagnósticos da América SA, Rua João Cachoeira, 743, Itaim Bibi, 04535-012, Sao Paulo, Sao Paulo, Brazil; Division of Neuroradiology, Santa Casa de Sao Paulo School of Medical Sciences, Rua Dr. Cesário Mota Júnior, 112, Vila Buarque, 01221-020, Sao Paulo, Sao Paulo, Brazil. https://twitter.com/ofelipe_pacheco
| | - Ana Paula Alves Fonseca
- Division of Neuroradiology, DASA - Diagnósticos da América SA, Rua João Cachoeira, 743, Itaim Bibi, 04535-012, Sao Paulo, Sao Paulo, Brazil
| | - Luiz Celso Hygino da Cruz
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Avenida das Américas, 4666, Barra da Tijuca, 2640-102, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Antônio José da Rocha
- Division of Neuroradiology, DASA - Diagnósticos da América SA, Rua João Cachoeira, 743, Itaim Bibi, 04535-012, Sao Paulo, Sao Paulo, Brazil; Division of Neuroradiology, Santa Casa de Sao Paulo School of Medical Sciences, Rua Dr. Cesário Mota Júnior, 112, Vila Buarque, 01221-020, Sao Paulo, Sao Paulo, Brazil
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5
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Silva TL, Corbiceiro WCH, Corrêa DG. Rhombencephalitis Caused by Cytomegalovirus. Can J Neurol Sci 2023; 50:905-906. [PMID: 36522675 DOI: 10.1017/cjn.2022.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Thallys Leal Silva
- Department of Radiology, Federal Fluminense University, Niterói, RJ, Brazil
| | | | - Diogo Goulart Corrêa
- Department of Radiology, Federal Fluminense University, Niterói, RJ, Brazil
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Rio de Janeiro, RJ, Brazil
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6
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Uchôa LRA, Lucato LT. Newer Updates in Pediatric Intracranial Infection. Semin Roentgenol 2023; 58:88-109. [PMID: 36732014 DOI: 10.1053/j.ro.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/24/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Luiz Ricardo Araújo Uchôa
- Neuroradiology Section, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.
| | - Leandro Tavares Lucato
- Neuroradiology Section, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil; Grupo Fleury, São Paulo, Brazil
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7
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Yang CWR, Mason M, Parizel PM, Warne R. Magnetic resonance imaging patterns of paediatric brain infections: a pictorial review based on the Western Australian experience. Insights Imaging 2022; 13:160. [PMID: 36194350 PMCID: PMC9532482 DOI: 10.1186/s13244-022-01298-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/10/2022] [Indexed: 12/01/2022] Open
Abstract
Paediatric brain infections are relatively uncommon, but it is important for radiologists to recognise the disease and provide accurate differential diagnoses. Magnetic resonance imaging (MRI) plays an important role in determining the most likely causative pathogen—either in the setting of an unwell child with acute infectious encephalitis, or in the evaluation of a child for sequela of prior infection. Image analysis can, however, be difficult since a particular pathogen can cause variable MRI findings across different geographic environments, and conversely, a particular appearance on MRI may be caused by a variety of pathogens. This educational review aims to identify some of the key MRI patterns seen in paediatric brain infections and present example cases encountered in Western Australia. Based on (i) the predominant type of signal abnormality (restricted diffusion versus T2 hyperintensity) and (ii) the distribution of signal abnormality throughout the brain, this review presents a framework of six key MRI patterns seen in paediatric brain infections, with an emphasis on acute infectious encephalitis. There is general utility to these MRI patterns—each suggestive of a group of likely diagnostic possibilities which can be calibrated according to institution and local environment. The pattern-based framework of this review can be easily transitioned into daily radiological practice, and we hope it facilitates the formation of accurate differential diagnoses in paediatric brain infections.
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Affiliation(s)
- Chi-Wei Robin Yang
- Department of Medical Imaging, Perth Children's Hospital (PCH), 15 Hospital Avenue, Nedlands, WA, 6009, Australia.
| | - Michael Mason
- Department of Medical Imaging, Perth Children's Hospital (PCH), 15 Hospital Avenue, Nedlands, WA, 6009, Australia
| | - Paul M Parizel
- Department of Radiology, University of Western Australia (UWA), Royal Perth Hospital (RPH), Perth, WA, Australia
| | - Richard Warne
- Department of Medical Imaging, Perth Children's Hospital (PCH), 15 Hospital Avenue, Nedlands, WA, 6009, Australia
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Vaughn JA, Goncalves LF, Cornejo P. Intrauterine and Perinatal Infections. Clin Perinatol 2022; 49:751-770. [PMID: 36113933 DOI: 10.1016/j.clp.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Imaging plays an important role in evaluating patients with suspected intrauterine and perinatal infections. Advances in fetal imaging including both ultrasound and MRI allow for increasingly more specific diagnosis if the radiologist is familiar with specific imaging features and patterns. Early imaging of neonates with suspected central nervous system infection is valuable to enable prompt treatment and differentiate infection from other conditions which can clinically present similarly. Ultrasound is a useful initial modality to screen for abnormalities however MRI with and without contrast remains the optimal examination to characterize infection, evaluate for potential surgical targets, and provide prognostic information.
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Affiliation(s)
- Jennifer A Vaughn
- Department of Radiology, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ 85016, USA; University of Arizona College of Medicine, Phoenix, AZ, USA; Creighton University School of Medicine, Phoenix, AZ, USA; Barrows Neurological Institute, Phoenix, AZ, USA.
| | - Luis F Goncalves
- Department of Radiology, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ 85016, USA; University of Arizona College of Medicine, Phoenix, AZ, USA; Creighton University School of Medicine, Phoenix, AZ, USA; Mayo Clinic, Scottsdale, AZ, USA
| | - Patricia Cornejo
- Department of Radiology, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ 85016, USA; University of Arizona College of Medicine, Phoenix, AZ, USA; Creighton University School of Medicine, Phoenix, AZ, USA; Barrows Neurological Institute, Phoenix, AZ, USA; Mayo Clinic, Scottsdale, AZ, USA
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9
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From Fetal to Neonatal Neuroimaging in TORCH Infections: A Pictorial Review. CHILDREN 2022; 9:children9081210. [PMID: 36010101 PMCID: PMC9406729 DOI: 10.3390/children9081210] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/06/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022]
Abstract
Congenital infections represent a challenging and varied clinical scenario in which the brain is frequently involved. Therefore, fetal and neonatal neuro-imaging plays a pivotal role in reaching an accurate diagnosis and in predicting the clinical outcome. Congenital brain infections are characterized by various clinical manifestations, ranging from nearly asymptomatic diseases to syndromic disorders, often associated with severe neurological symptoms. Brain damage results from the complex interaction among the infectious agent, its specific cellular tropism, and the stage of development of the central nervous system at the time of the maternal infection. Therefore, neuroradiological findings vary widely and are the result of complex events. An early detection is essential to establishing a proper diagnosis and prognosis, and to guarantee an optimal and prompt therapeutic perinatal management. Recently, emerging infective agents (i.e., Zika virus and SARS-CoV2) have been related to possible pre- and perinatal brain damage, thus expanding the spectrum of congenital brain infections. The purpose of this pictorial review is to provide an overview of the current knowledge on fetal and neonatal brain neuroimaging patterns in congenital brain infections used in clinical practice.
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10
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Feige L, Zaeck LM, Sehl-Ewert J, Finke S, Bourhy H. Innate Immune Signaling and Role of Glial Cells in Herpes Simplex Virus- and Rabies Virus-Induced Encephalitis. Viruses 2021; 13:2364. [PMID: 34960633 PMCID: PMC8708193 DOI: 10.3390/v13122364] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/12/2021] [Accepted: 11/18/2021] [Indexed: 12/19/2022] Open
Abstract
The environment of the central nervous system (CNS) represents a double-edged sword in the context of viral infections. On the one hand, the infectious route for viral pathogens is restricted via neuroprotective barriers; on the other hand, viruses benefit from the immunologically quiescent neural environment after CNS entry. Both the herpes simplex virus (HSV) and the rabies virus (RABV) bypass the neuroprotective blood-brain barrier (BBB) and successfully enter the CNS parenchyma via nerve endings. Despite the differences in the molecular nature of both viruses, each virus uses retrograde transport along peripheral nerves to reach the human CNS. Once inside the CNS parenchyma, HSV infection results in severe acute inflammation, necrosis, and hemorrhaging, while RABV preserves the intact neuronal network by inhibiting apoptosis and limiting inflammation. During RABV neuroinvasion, surveilling glial cells fail to generate a sufficient type I interferon (IFN) response, enabling RABV to replicate undetected, ultimately leading to its fatal outcome. To date, we do not fully understand the molecular mechanisms underlying the activation or suppression of the host inflammatory responses of surveilling glial cells, which present important pathways shaping viral pathogenesis and clinical outcome in viral encephalitis. Here, we compare the innate immune responses of glial cells in RABV- and HSV-infected CNS, highlighting different viral strategies of neuroprotection or Neuroinflamm. in the context of viral encephalitis.
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Affiliation(s)
- Lena Feige
- Institut Pasteur, Université de Paris, Lyssavirus Epidemiology and Neuropathology, 28 Rue Du Docteur Roux, 75015 Paris, France;
| | - Luca M. Zaeck
- Institute of Molecular Virology and Cell Biology, Friedrich-Loeffler-Institut (FLI), Federal Institute of Animal Health, Südufer 10, 17493 Greifswald-Insel Riems, Germany; (L.M.Z.); (S.F.)
| | - Julia Sehl-Ewert
- Department of Experimental Animal Facilities and Biorisk Management, Friedrich-Loeffler-Institut (FLI), Federal Institute of Animal Health, Südufer 10, 17493 Greifswald-Insel Riems, Germany;
| | - Stefan Finke
- Institute of Molecular Virology and Cell Biology, Friedrich-Loeffler-Institut (FLI), Federal Institute of Animal Health, Südufer 10, 17493 Greifswald-Insel Riems, Germany; (L.M.Z.); (S.F.)
| | - Hervé Bourhy
- Institut Pasteur, Université de Paris, Lyssavirus Epidemiology and Neuropathology, 28 Rue Du Docteur Roux, 75015 Paris, France;
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11
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High-resolution intracranial vessel wall imaging in cerebral viral infections evaluations. Neuroradiology 2021; 64:915-924. [PMID: 34657167 PMCID: PMC8520459 DOI: 10.1007/s00234-021-02831-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022]
Abstract
Purpose Vascular complications can be seen in various viral CNS infections. Variable neuro-imaging findings have been described in the literature elucidating the parenchymal changes with vascular involvement. Vessel wall imaging (VWI) can help to detect these vascular involvements. We aimed to describe the role and usefulness of VWI in the evaluation of various viral CNS infections. Methods In this prospective study, we included 15 cases of various diagnosed viral CNS infections (varicella, HIV encephalopathy, HSV encephalitis, Japanese encephalitis, dengue, COVID-19). VWI and time-of-flight MR angiography (TOF MRA) were included in imaging protocol. All cases were evaluated for the presence of cerebral parenchymal changes, vascular enhancement, and vascular stenosis. Results We found infarctions in all 5 cases of varicella, 1 case of HIV encephalopathy, and 1 case of COVID-19 encephalopathy. All these cases also showed vascular enhancement and stenosis on VWI. The rest of the cases, including 1 case of HIV encephalopathy, 3 cases of herpes encephalitis, 2 cases of dengue, and 2 cases of Japanese encephalitis did not have any vascular complication, and also did not show vascular enhancement or stenosis. Conclusion VWI can be useful in the detection of vascular involvement in various viral infections of CNS which show a relatively higher cerebrovascular complication rate like varicella, HIV encephalopathy, and COVID-19. However, VWI may not be useful in the routine evaluation of other viral infections like herpes, dengue, and Japanese encephalitis, which have a very low rate of cerebrovascular complication rate.
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Macedo-da-Silva J, Rosa-Fernandes L, Barbosa RH, Angeli CB, Carvalho FR, de Oliveira Vianna RA, Carvalho PC, Larsen MR, Cardoso CA, Palmisano G. Serum Proteomics Reveals Alterations in Protease Activity, Axon Guidance, and Visual Phototransduction Pathways in Infants With In Utero Exposure to Zika Virus Without Congenital Zika Syndrome. Front Cell Infect Microbiol 2020; 10:577819. [PMID: 33312964 PMCID: PMC7708324 DOI: 10.3389/fcimb.2020.577819] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/20/2020] [Indexed: 12/21/2022] Open
Abstract
In 2015, ZIKV infection attracted international attention during an epidemic in the Americas, when neurological disorders were reported in infants who had their mothers exposed to ZIKV during pregnancy. World Health Organization (WHO) epidemiological data show that 5 to 15% of neonates exposed to ZIKV in the uterus have complications included in abnormalities related to Congenital Zika Syndrome (CZS). The risk of complications after birth is not well documented, however, clinical evidence shows that 6% of infants exposed to ZIKV during pregnancy have complications present at birth, and this rate rises to 14% when medical monitoring is performed in all exposed infants, regardless of birth condition. Thus, the evaluation and monitoring of all exposed infants are of foremost importance as the development of late complications has been increasingly supported by clinical evidence. The identification of changes in protein profile of infants exposed to ZIKV without CZS could provide valuable findings to better understand molecular changes in this cohort. Here, we use a shotgun-proteomics approach to investigate alterations in the serum of infants without CZS symptoms but exposed to intrauterine ZIKV (ZIKV) compared to unexposed controls (CTRL). A complex pattern of differentially expressed proteins was identified, highlighting the dysregulation of proteins involved in axon orientation, visual phototransduction, and global protease activity in children exposed to ZIKV without CZS. These data support the importance of monitoring children exposed to ZIKV during gestation and without early CZS symptoms. Our study is the first to assess molecular evidence of possible late disorders in children victims of the ZIKV outbreak in the Americas. We emphasize the importance of medical monitoring of symptomatic and asymptomatic children, as apparently unexplained late neurological and eye disorders may be due to intrauterine ZIKV exposure.
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Affiliation(s)
- Janaina Macedo-da-Silva
- GlycoProteomics Laboratory, Department of Parasitology, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
- Laboratory for Structural and Computational Proteomics, Carlos Chagas Institute, Fiocruz, Curitiba, Brazil
| | - Lívia Rosa-Fernandes
- GlycoProteomics Laboratory, Department of Parasitology, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Raquel Hora Barbosa
- Maternal and Child Department, School of Medicine, Universidade Federal Fluminense, Niteroi, Brazil
| | - Claudia B. Angeli
- GlycoProteomics Laboratory, Department of Parasitology, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | - Fabiana Rabe Carvalho
- Maternal and Child Department, School of Medicine, Universidade Federal Fluminense, Niteroi, Brazil
- Multiuser Laboratory for Research in Nephrology and Medical Sciences (LAMAP), School of Medicine, Universidade Federal Fluminense, Niteroi, Brazil
| | - Renata Artimos de Oliveira Vianna
- Maternal and Child Department, School of Medicine, Universidade Federal Fluminense, Niteroi, Brazil
- Multiuser Laboratory for Research in Nephrology and Medical Sciences (LAMAP), School of Medicine, Universidade Federal Fluminense, Niteroi, Brazil
| | - Paulo C. Carvalho
- Laboratory for Structural and Computational Proteomics, Carlos Chagas Institute, Fiocruz, Curitiba, Brazil
| | - Martin R. Larsen
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
| | - Claudete Araújo Cardoso
- Maternal and Child Department, School of Medicine, Universidade Federal Fluminense, Niteroi, Brazil
- Multiuser Laboratory for Research in Nephrology and Medical Sciences (LAMAP), School of Medicine, Universidade Federal Fluminense, Niteroi, Brazil
| | - Giuseppe Palmisano
- GlycoProteomics Laboratory, Department of Parasitology, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo, Brazil
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Moltoni G, D'Arco F, Pasquini L, Carducci C, Bhatia A, Longo D, Kaliakatsos M, Lancella L, Romano A, Di Napoli A, Bozzao A, Rossi-Espagnet MC. Non-congenital viral infections of the central nervous system: from the immunocompetent to the immunocompromised child. Pediatr Radiol 2020; 50:1757-1767. [PMID: 32651625 DOI: 10.1007/s00247-020-04746-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/14/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
Abstract
Non-congenital viral infections of the central nervous system in children can represent a severe clinical condition that needs a prompt diagnosis and management. However, the aetiological diagnosis can be challenging because symptoms are often nonspecific and cerebrospinal fluid analysis is not always diagnostic. In this context, neuroimaging represents a helpful tool, even though radiologic patterns sometimes overlap. The purpose of this pictorial essay is to suggest a schematic representation of different radiologic patterns of non-congenital viral encephalomyelitis based on the predominant viral tropism and vulnerability of specific regions: cortical grey matter, deep grey matter, white matter, brainstem, cerebellum and spine.
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Affiliation(s)
- Giulia Moltoni
- Neuroradiology Unit, NESMOS Department, Sapienza University, Rome, Italy
| | - Felice D'Arco
- Neuroradiology Unit, Great Ormond Street Hospital, London, UK
| | - Luca Pasquini
- Neuroradiology Unit, NESMOS Department, Sapienza University, Rome, Italy
- Neuroradiology Unit, IRCCS Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00100, Rome, Italy
| | - Chiara Carducci
- Neuroradiology Unit, IRCCS Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00100, Rome, Italy
| | - Aashim Bhatia
- Neuroradiology Unit, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Daniela Longo
- Neuroradiology Unit, IRCCS Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00100, Rome, Italy
| | - Marios Kaliakatsos
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Laura Lancella
- Pediatric and Infectious Diseases Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Andrea Romano
- Neuroradiology Unit, NESMOS Department, Sapienza University, Rome, Italy
| | - Alberto Di Napoli
- Neuroradiology Unit, NESMOS Department, Sapienza University, Rome, Italy
| | - Alessandro Bozzao
- Neuroradiology Unit, NESMOS Department, Sapienza University, Rome, Italy
| | - Maria Camilla Rossi-Espagnet
- Neuroradiology Unit, NESMOS Department, Sapienza University, Rome, Italy.
- Neuroradiology Unit, IRCCS Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00100, Rome, Italy.
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Kweh BTS, Lee HQ, Tee JW. Intracranial peripherally enhancing lesions in cardiac transplant recipients: A rare case series and literature review. J Clin Neurosci 2020; 78:284-290. [PMID: 32331940 DOI: 10.1016/j.jocn.2020.04.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/05/2020] [Indexed: 12/26/2022]
Abstract
Intracranial peripherally enhancing lesions in immunosuppressed solid organ transplant recipients represent a unique diagnostic and management dilemma due to the vast array of differentials that demand consideration. Diagnosis of the underlying pathology is often guided by the use of magnetic resonance imaging (MRI). We present the first published case series of three cardiac transplant recipients with significantly atypical neuroradiological findings contrary to the tenets of contemporary literature. Our rare case series consists of: (1) A sterile Mycobacterium pyogenic abscess mimicking glioblastoma multiforme due to an immunosuppressed state (2) Epstein Barr Virus encephalitis masquerading as Central Nervous System Post-Transplant Lymphoproliferative Disorder (3) An unusual case of partially treated disseminated Nocardiosis warning of the need to consider the immunosuppressed state and partial treatment response obfuscating classical MRI appearances. We utilise these unprecedented cases as the basis of a literature review to understand the pathophysiology behind the peculiar imaging findings in this rarefied cohort of transplant recipients, and rationalise why the MRI findings in each instance contradicts the accepted imaging patterns. In the setting of potential unreliability of neuroradiology in this immunosuppressed unique subgroup, we hope to impart to clinicians that definitive diagnosis obtained by emergent neurosurgical intervention may be necessary to accurately and expediently guide further medical management.
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Affiliation(s)
- Barry Ting Sheen Kweh
- National Trauma Research Institute, Melbourne, Victoria 3004, Australia; Department of Neurosurgery, Level 1, Old Baker Building, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Hui Qing Lee
- National Trauma Research Institute, Melbourne, Victoria 3004, Australia; Department of Neurosurgery, Level 1, Old Baker Building, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Jin Wee Tee
- National Trauma Research Institute, Melbourne, Victoria 3004, Australia; Department of Neurosurgery, Level 1, Old Baker Building, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.
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15
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Neuroimagen en la encefalitis por virus Epstein-Barr. An Pediatr (Barc) 2020; 92:53-54. [DOI: 10.1016/j.anpedi.2018.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/02/2018] [Accepted: 09/10/2018] [Indexed: 11/15/2022] Open
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16
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Pool KL, Adachi K, Karnezis S, Salamon N, Romero T, Nielsen-Saines K, Pone S, Boechat M, Aibe M, Gomes da Silva T, Ribeiro CTM, Boechat MI, Brasil P, Zin A, Tsui I, Gaw SL, Daltro P, Ribeiro BG, Fazecas T, Hygino da Cruz LC, Nogueira R, Vasconcelos Z, Pereira JP, Saad Salles T, Barbosa CN, Chen W, Foo SS, Jung J, Moreira ME, Pone M. Association Between Neonatal Neuroimaging and Clinical Outcomes in Zika-Exposed Infants From Rio de Janeiro, Brazil. JAMA Netw Open 2019; 2:e198124. [PMID: 31365112 PMCID: PMC6669783 DOI: 10.1001/jamanetworkopen.2019.8124] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
IMPORTANCE Congenital Zika virus (ZIKV) infection may present with a spectrum of clinical and neuroradiographic findings. OBJECTIVE To determine whether neuroimaging findings for infants with a history of ZIKV exposure are associated with infant clinical outcomes and gestational age at antenatal ZIKV infection. DESIGN, SETTING, AND PARTICIPANTS This cohort study retrospectively reviewed neuroimaging results (computed tomography and/or magnetic resonance imaging scans) of 110 ZIKV-exposed infants from a maternity and children's hospital in Rio de Janeiro, Brazil, following the 2015 to 2016 ZIKV epidemic. Neuroimaging from March 1, 2016, to June 30, 2017, was evaluated to determine whether findings were associated with clinical outcomes and the timing of maternal ZIKV infection. Data were analyzed from July 1, 2017, to August 30, 2018. EXPOSURES Neuroimaging (computed tomography and/or magnetic resonance imaging) was performed on ZIKV-exposed infants after birth. Blood and/or urine specimens from mothers and infants were tested for ZIKV by polymerase chain reaction assay. MAIN OUTCOMES AND MEASURES Neuroimaging studies were evaluated for structural abnormalities and other forms of brain injury. RESULTS A total of 110 infants with a mean (SD) gestational age of 38.4 (2.1) weeks had neuroimaging and clinical outcome data reviewed. Of these, 71 (65%) had abnormal neuroimaging findings, with the majority (96%) classified as having severe ZIKV infection at birth. The most common neuroimaging abnormalities were structural abnormalities including brain calcifications, especially at the cortico-subcortical white matter junction, cortex malformations, ventriculomegaly, and reduced brain volumes, followed by brainstem hypoplasia, cerebellar hypoplasia, and corpus callosum abnormalities. Frequency of abnormal imaging was higher in infants with specific clinical findings as opposed to those without them; these findings included fetal brain disruption sequence (100% vs 35%), microcephaly (100% vs 30%), congenital contractures (100% vs 58%), ophthalmologic abnormalities (95% vs 44%), hearing abnormalities (100% vs 58%), and neurologic symptoms (94% vs 10%). Four of 39 infants (10%) without initial evidence of severe ZIKV infection and normal findings on neurologic evaluation at birth had abnormal neuroimaging findings. Neuroimaging abnormalities differed by trimester of maternal ZIKV infection, with 63% of infants born to mothers infected in the first trimester, 13% of infants born to mothers infected in the second trimester, and 1% of infants born to mothers infected in the third trimester exhibiting neuroimaging abnormalities. The odds of abnormal neuroimaging were 7.9 times greater for infants with first trimester ZIKV exposure compared with other trimesters combined (odds ratio, 7.9; 95% CI, 3.0-20.4; P < .001). CONCLUSIONS AND RELEVANCE Neuroimaging abnormalities of computed tomography and/or magnetic resonance imaging scans were common in ZIKV-exposed infants. While neuroimaging abnormalities were seen in 10% of infants without clinically severe ZIKV, most occurred almost exclusively among those with clinically severe ZIKV, especially among those with a history of ZIKV exposure in the first trimester.
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Affiliation(s)
- Kara-Lee Pool
- David Geffen School of Medicine, University of California, Los Angeles
| | - Kristina Adachi
- David Geffen School of Medicine, University of California, Los Angeles
| | - Stellios Karnezis
- David Geffen School of Medicine, University of California, Los Angeles
| | - Noriko Salamon
- David Geffen School of Medicine, University of California, Los Angeles
| | - Tahmineh Romero
- David Geffen School of Medicine, University of California, Los Angeles
| | | | - Sheila Pone
- Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Mitsue Aibe
- Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | | | - M. Ines Boechat
- David Geffen School of Medicine, University of California, Los Angeles
| | | | - Andrea Zin
- Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Irena Tsui
- David Geffen School of Medicine, University of California, Los Angeles
| | | | - Pedro Daltro
- Clinica de Diagnostico por Imagem CDPI, Rio de Janeiro, Brazil
| | | | - Tatiana Fazecas
- Clinica de Diagnostico por Imagem CDPI, Rio de Janeiro, Brazil
| | | | - Renata Nogueira
- Clinica de Diagnostico por Imagem CDPI, Rio de Janeiro, Brazil
| | | | | | | | | | - Weiqiang Chen
- University of Southern California School of Medicine, Los Angeles
| | - Suan-Sin Foo
- University of Southern California School of Medicine, Los Angeles
| | - Jae Jung
- University of Southern California School of Medicine, Los Angeles
| | | | - Marcos Pone
- Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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18
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Abstract
Vascular injury is increasingly recognized as an important cause of mortality and morbidity in children (29 days to 18 years of age). Since vascular brain injury in children appears to be less common than in adults, the index of suspicion for vascular brain injury is usually lower. In this review article, we describe frequent and rare conditions underlying pediatric stroke including cardioembolic, viral, autoimmune, post-traumatic, and genetic etiologies. Furthermore, we provide a neuroimaging correlate for clinical mimics of pediatric stroke. This review highlights the role of multimodal noninvasive neuroimaging in the early diagnosis of pediatric stroke, providing a problem-solving approach to the differential diagnosis for the neuroradiologist, emergency room physician, and neurologist.
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19
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Infections: Viruses. IMAGING BRAIN DISEASES 2019. [PMCID: PMC7120597 DOI: 10.1007/978-3-7091-1544-2_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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20
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Abstract
Viruses are a frequent cause of encephalitis. Common or important viruses causing encephalitis include herpesviruses, arboviruses, enteroviruses, parechoviruses, mumps, measles, rabies, Ebola, lymphocytic choriomeningitis virus, and henipaviruses. Other viruses may cause an encephalopathy. Host factors and clinical features of infection are important to consider in identifying the cause for encephalitis. Cerebrospinal fluid evaluation, serologic/polymerase chain reaction studies, and neuroimaging are cornerstones of diagnostic evaluation in encephalitis. Treatable forms of encephalitis are important to consider in all cases. Central nervous system inflammation may also occur because of postinfectious autoimmunity, such as acute disseminated encephalomyelitis or antibody-mediated encephalitis after herpes simplex virus encephalitis.
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Affiliation(s)
- Arun Venkatesan
- Division of Neuroimmunology and Neuroinfectious Diseases, Department of Neurology, Johns Hopkins Encephalitis Center, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, MD 21287, USA.
| | - Olwen C Murphy
- Division of Neuroimmunology and Neuroinfectious Diseases, Department of Neurology, Johns Hopkins Encephalitis Center, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, MD 21287, USA
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21
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Neuberger I, Garcia J, Meyers ML, Feygin T, Bulas DI, Mirsky DM. Imaging of congenital central nervous system infections. Pediatr Radiol 2018; 48:513-523. [PMID: 29550865 DOI: 10.1007/s00247-018-4092-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/08/2018] [Accepted: 01/19/2018] [Indexed: 10/17/2022]
Abstract
Congenital central nervous system (CNS) infections are a cause of significant morbidity and mortality. The recent Zika virus outbreak raised awareness of congenital CNS infections. Imaging can be effective in diagnosing the presence and severity of infection. In this paper we review the clinical presentations and imaging characteristics of several common and less common congenital CNS infections.
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Affiliation(s)
- Ilana Neuberger
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Ave., Box B125, Aurora, CO, 80045, USA
| | - Jacquelyn Garcia
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Ave., Box B125, Aurora, CO, 80045, USA
| | - Mariana L Meyers
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Ave., Box B125, Aurora, CO, 80045, USA
| | - Tamara Feygin
- Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Dorothy I Bulas
- Department of Radiology, Children's National Health System, George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - David M Mirsky
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Ave., Box B125, Aurora, CO, 80045, USA.
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22
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Abstract
Congenital Zika syndrome is a set of congenital anomalies associated with Zika virus infection during pregnancy. We present the unique case of a neonate born to a suspected Zika virus-positive mother that developed an embolic stroke and medication-resistant seizures. This report may impact the evolving definition of congenital Zika syndrome.
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23
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Dekeyzer S, De Kock I, Nikoubashman O, Vanden Bossche S, Van Eetvelde R, De Groote J, Acou M, Wiesmann M, Deblaere K, Achten E. "Unforgettable" - a pictorial essay on anatomy and pathology of the hippocampus. Insights Imaging 2017; 8:199-212. [PMID: 28108955 PMCID: PMC5359145 DOI: 10.1007/s13244-016-0541-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 12/18/2016] [Accepted: 12/20/2016] [Indexed: 11/24/2022] Open
Abstract
Abstract The hippocampus is a small but complex anatomical structure that plays an important role in spatial and episodic memory. The hippocampus can be affected by a wide range of congenital variants and degenerative, inflammatory, vascular, tumoral and toxic-metabolic pathologies. Magnetic resonance imaging is the preferred imaging technique for evaluating the hippocampus. The main indications requiring tailored imaging sequences of the hippocampus are medically refractory epilepsy and dementia. The purpose of this pictorial review is threefold: (1) to review the normal anatomy of the hippocampus on MRI; (2) to discuss the optimal imaging strategy for the evaluation of the hippocampus; and (3) to present a pictorial overview of the most common anatomic variants and pathologic conditions affecting the hippocampus. Teaching points • Knowledge of normal hippocampal anatomy helps recognize anatomic variants and hippocampal pathology. • Refractory epilepsy and dementia are the main indications requiring dedicated hippocampal imaging. • Pathologic conditions centered in and around the hippocampus often have similar imaging features. • Clinical information is often necessary to come to a correct diagnosis or an apt differential.
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Affiliation(s)
- Sven Dekeyzer
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany. .,Department of Radiology, University Hospital (UZ) Ghent, De Pintelaan 185, 9000, Ghent, Belgium. .,Department of Medical Imaging, Onze-Lieve-Vrouw Hospital (OLV) Aalst, Moorselbaan 164, 9300, Aalst, Belgium.
| | - Isabelle De Kock
- Department of Radiology, University Hospital (UZ) Ghent, De Pintelaan 185, 9000, Ghent, Belgium
| | - Omid Nikoubashman
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | | | - Ruth Van Eetvelde
- Department of Radiology, University Hospital (UZ) Ghent, De Pintelaan 185, 9000, Ghent, Belgium.,Department of Medical Imaging, Onze-Lieve-Vrouw Hospital (OLV) Aalst, Moorselbaan 164, 9300, Aalst, Belgium
| | - Jeroen De Groote
- Department of Radiology, University Hospital (UZ) Ghent, De Pintelaan 185, 9000, Ghent, Belgium
| | - Marjan Acou
- Department of Radiology, University Hospital (UZ) Ghent, De Pintelaan 185, 9000, Ghent, Belgium
| | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Karel Deblaere
- Department of Radiology, University Hospital (UZ) Ghent, De Pintelaan 185, 9000, Ghent, Belgium
| | - Eric Achten
- Department of Radiology, University Hospital (UZ) Ghent, De Pintelaan 185, 9000, Ghent, Belgium
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24
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Herpes simplex encephalitis in an immunocompromised adult with novel MRI and pathology findings. Clin Neuroradiol 2016; 27:231-234. [PMID: 27557804 DOI: 10.1007/s00062-016-0536-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
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25
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Sanchez TR, Datlow MD, Nidecker AE. Diffuse periventricular calcification and brain atrophy: A case of neonatal central nervous system cytomegalovirus infection. Neuroradiol J 2016; 29:314-6. [PMID: 27531861 DOI: 10.1177/1971400916665372] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
TORCH refers to the most common congenitally acquired infections: toxoplasma, rubella, cytomegalovirus, and herpes simplex virus. Neonatal cytomegalovirus infection remains a common cause of congenital infection worldwide with effects ranging from hearing impairment to significant neurological morbidity. We report a case of a term neonate with ventriculomegaly on prenatal ultrasound who presented with low birth weight, small head circumference, hepatosplenomegaly, and purpuric rash on physical exam. Central nervous system cytomegalovirus infection typically shows periventricular calcifications and associated deep white matter damage and ventriculomegaly. Ultrasound, computed tomography, and magnetic resonance imaging have different roles in the diagnosis of congenital central nervous system cytomegalovirus infection. Many imaging features of congenital cytomegalovirus are distinctive, and can spur a diagnostic work-up as well as help provide a prognosis.
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Affiliation(s)
| | | | - Anna E Nidecker
- Division of Pediatric Radiology, University of California, USA
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26
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Abstract
OBJECTIVE Herpesviridae are a family of DNA viruses remarkable for their ability to both promote acute infection and enter a latent phase with potential of reactivation. Herpes infections are ubiquitous throughout the human life span, regardless of the degree of immunocompetence. CONCLUSION We review the virology and clinical manifestations of each herpesvirus, with emphasis on recent advances in knowledge and characteristic neuroimaging findings important for diagnosis and appropriate clinical management.
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27
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Çelik T, Çelik Ü, Tolunay O, Kömür M, Başpınar H, Yılmaz C, Mert G, Yıldızdaş D. Epstein-Barr virus encephalitis with substantia nigra involvement. J Pediatr Neurosci 2016; 10:401-3. [PMID: 26962357 PMCID: PMC4770663 DOI: 10.4103/1817-1745.174436] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Infectious mononucleosis due to Epstein-Barr virus (EBV) is a usually benign systemic viral illness common in children. Many studies described nervous system manifestations of infectious mononucleosis with a wide spectrum of neurologic deficits. Neurologic complications of EBV are seen in both acute and reactivate infection. Herein, we describe a patient diagnosed by acute EBV encephalitis with substantia nigra involvement and excellent clinical recovery.
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Affiliation(s)
- Tamer Çelik
- Department of Pediatrics, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Ümit Çelik
- Department of Pediatrics, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Orkun Tolunay
- Department of Pediatrics, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Mustafa Kömür
- Department of Pediatrics, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Hüseyin Başpınar
- Department of Pediatrics, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Cengiz Yılmaz
- Department of Radiology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Gülen Mert
- Department of Pediatrics, Cukurova University School of Medicine, Adana, Turkey
| | - Dinçer Yıldızdaş
- Department of Pediatrics, Cukurova University School of Medicine, Adana, Turkey
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28
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Shen Y, Tu J, Liu H, Dai T, Wu W. Epstein-Barr virus infection involving bilateral middle cerebellar peduncles in an old woman: a case report. Neurol Sci 2015; 37:479-81. [DOI: 10.1007/s10072-015-2431-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/26/2015] [Indexed: 11/27/2022]
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29
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Pinto J, Carvalho S, Pereira C, Figueira C, Robalo C. A case of Epstein-Barr encephalitis with some curiosities. Neuroradiol J 2015; 28:559-61. [PMID: 26481185 DOI: 10.1177/1971400915602802] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We present the magnetic resonance imaging findings of an eight-year-old boy with Epstein-Barr virus (EBV) encephalitis, with special attention to lesion neuroanatomic distribution, diffusion-weighted images, and proton magnetic resonance spectroscopy (MRS). T2 and FLAIR-weighted images showed bilateral and symmetric basal nuclei lesions, with diffusion facilitation. MRS of the lesions demonstrated elevated lactate/lipid and excitatory neurotransmitters. The purpose of this report is to alert to this imagiologic pattern of EBV infection, and in particular to the fact that facilitated diffusion does occur on EBV encephalitis.
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Affiliation(s)
- Joana Pinto
- Resident Neuroradiology, CHUC Quinta dos Vales, S. Martinho do Bispo, Coimbra 3000, Portugal
| | - Sílvia Carvalho
- Resident Neuroradiology, CHUC Quinta dos Vales, S. Martinho do Bispo, Coimbra 3000, Portugal
| | - Cristina Pereira
- Resident Neuroradiology, CHUC Quinta dos Vales, S. Martinho do Bispo, Coimbra 3000, Portugal
| | - Carolina Figueira
- Resident Neuroradiology, CHUC Quinta dos Vales, S. Martinho do Bispo, Coimbra 3000, Portugal
| | - Conceição Robalo
- Resident Neuroradiology, CHUC Quinta dos Vales, S. Martinho do Bispo, Coimbra 3000, Portugal
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30
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Rangankar V, Dongre A, Hadgaonkar M, Singh H. Subcortical cysts in anterior temporal regions: Unusual imaging finding in congenital cytomegalovirus infection. Med J Armed Forces India 2015; 71:S230-3. [PMID: 26265842 DOI: 10.1016/j.mjafi.2014.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 04/24/2014] [Indexed: 10/24/2022] Open
Affiliation(s)
- Varsha Rangankar
- Associate Professor (Radiology), Smt. Kashibai Navale Medical College, Narhe, Pune 411041, India
| | - Aditi Dongre
- Lecturer (Radiology), Smt. Kashibai Navale Medical College, Narhe, Pune 411041, India
| | - Manisha Hadgaonkar
- Lecturer (Radiology), Smt. Kashibai Navale Medical College, Narhe, Pune 411041, India
| | - Hariqbal Singh
- Professor and Head (Radiology), Smt. Kashibai Navale Medical College, Narhe, Pune 411041, India
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31
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Slifer CM, Jennings SR. Battling the spread: Herpes simplex virus and encephalitis. Immunol Cell Biol 2015; 93:839-40. [PMID: 26259929 DOI: 10.1038/icb.2015.73] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Christina M Slifer
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Stephen R Jennings
- Department of Microbiology and Immunology, Drexel University College of Medicine, Philadelphia, PA, USA
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32
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Zuccoli G, Yannes MP, Nardone R, Bailey A, Goldstein A. Bilateral symmetrical basal ganglia and thalamic lesions in children: an update (2015). Neuroradiology 2015; 57:973-89. [DOI: 10.1007/s00234-015-1568-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/15/2015] [Indexed: 01/09/2023]
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33
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Imaging in Neurologic Infections II: Fungal and Viral Diseases. Curr Infect Dis Rep 2015; 17:474. [PMID: 25870142 DOI: 10.1007/s11908-015-0474-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Infections of the nervous system have a significant impact on global mortality and morbidity. These infections are medical emergencies that are frequently diagnostically challenging. Incorporation of neuroimaging can be essential for early diagnosis and initiation of proper treatment. In this second part of this two-part review, we focus on diagnostic imaging features of selected fungal and viral nervous system infections.
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Barberi W, Perrone S, Iori AP, Torelli GF, Testi AM, Moleti ML, Ceglie T, Papoff P, Caresta E, Antonelli M, Gianno F, Melone A, Badiali M, Giangaspero F, Foà R, Gentile G. Proven Epstein-Barr encephalitis with negative EBV-DNA load in cerebrospinal fluid after allogeneic hematopoietic stem cell transplantation in a child with acute lymphoblastic leukemia. Pediatr Transplant 2015; 19:E19-24. [PMID: 25388950 PMCID: PMC7167730 DOI: 10.1111/petr.12386] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2014] [Indexed: 12/19/2022]
Abstract
We report a case of EBV encephalitis in a seven-yr-old child with Ph+ ALL. Two months after an allogeneic HSCT from his HLA mismatched mother, the patient showed an altered sensorium, generalized seizures, and a left hemiparesis. Brain MRI demonstrated multiple lesions highly suggestive for viral encephalitis. Blood and CSF PCR analyses were negative for the most common viruses involved in immunocompromised patients including EBV. A cerebral biopsy was performed, which showed intense gliosis and perivascular lymphocytic cuffing. PCR analysis performed on brain tissue was positive only for the EBV genome, while extensive investigations for other viral infections were negative. The patient's neurological symptoms rapidly worsened and he died two months later. This case report suggests that in patients presenting neurological and radiological signs of encephalitis after an HSCT, an EBV involvement should be considered, even in the absence of CSF and blood PCR virus detection.
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Affiliation(s)
- Walter Barberi
- Division of HematologyDepartment of Cellular Biotechnologies and Hematology“Sapienza” UniversityRomeItaly
| | - Salvatore Perrone
- Division of HematologyDepartment of Cellular Biotechnologies and Hematology“Sapienza” UniversityRomeItaly
| | - Anna Paola Iori
- Division of HematologyDepartment of Cellular Biotechnologies and Hematology“Sapienza” UniversityRomeItaly
| | - Giovanni Fernando Torelli
- Division of HematologyDepartment of Cellular Biotechnologies and Hematology“Sapienza” UniversityRomeItaly
| | - Anna Maria Testi
- Division of HematologyDepartment of Cellular Biotechnologies and Hematology“Sapienza” UniversityRomeItaly
| | - Maria Luisa Moleti
- Division of HematologyDepartment of Cellular Biotechnologies and Hematology“Sapienza” UniversityRomeItaly
| | - Teresa Ceglie
- Division of HematologyDepartment of Cellular Biotechnologies and Hematology“Sapienza” UniversityRomeItaly
| | - Paola Papoff
- Department of Pediatrics, Pediatric Emergency and Intensive Care“Sapienza” UniversityRomeItaly
| | - Elena Caresta
- Department of Pediatrics, Pediatric Emergency and Intensive Care“Sapienza” UniversityRomeItaly
| | - Manila Antonelli
- Department of Radiological, Oncological and Anatomo‐Pathological Sciences“Sapienza” UniversityRomeItaly
| | - Francesca Gianno
- Department of Radiological, Oncological and Anatomo‐Pathological Sciences“Sapienza” UniversityRomeItaly
| | - Antonio Melone
- Division of RadiologyEmergency Department“Sapienza” UniversityRomeItaly
| | - Manuela Badiali
- Bone Marrow Transplantion UnitDepartment Public Health, Clinical and Molecular MedicineOspedale Pediatrico MicrocitemicoCagliariItaly
| | - Felice Giangaspero
- Department of Radiological, Oncological and Anatomo‐Pathological Sciences“Sapienza” UniversityRomeItaly,Neuromed InstituteIRCCSPozzilliItaly
| | - Robin Foà
- Division of HematologyDepartment of Cellular Biotechnologies and Hematology“Sapienza” UniversityRomeItaly
| | - Giuseppe Gentile
- Division of HematologyDepartment of Cellular Biotechnologies and Hematology“Sapienza” UniversityRomeItaly
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Epstein-barr virus encephalitis in infancy. W INDIAN MED J 2014; 63:206-7. [PMID: 25303265 DOI: 10.7727/wimj.2014.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 02/13/2014] [Indexed: 11/18/2022]
Abstract
Epstein-Barr virus (EBV) infection causes a wide spectrum of illness in humans including subclinical infection, infectious mononucleosis, and is associated with some malignancies. This report presents the clinical findings of an unusual case of EBV encephalitis in a 10-month old infant who presented with a febrile infection and seizures. The clinical manifestations, serologic study and a dynamic change of EBV DNA in cerebrospinal fluid with spontaneous recovery confirmed the diagnosis of EBV infection of the nervous system.
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Spatola M, Du Pasquier RA. Immune system's role in viral encephalitis. Rev Neurol (Paris) 2014; 170:577-83. [PMID: 25189678 DOI: 10.1016/j.neurol.2014.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 07/25/2014] [Indexed: 10/24/2022]
Abstract
Viral infections can be a major thread for the central nervous system (CNS), therefore, the immune system must be able to mount a highly proportionate immune response, not too weak, which would allow the virus to proliferate, but not too strong either, to avoid collateral damages. Here, we aim at reviewing the immunological mechanisms involved in the host defense in viral CNS infections. First, we review the specificities of the innate as well as the adaptive immune responses in the CNS, using several examples of various viral encephalitis. Then, we focus on three different modes of interactions between viruses and immune responses, namely human Herpes virus-1 encephalitis with the defect in innate immune response which favors this disease; JC virus-caused progressive multifocal leukoencephalopathy and the crucial role of adaptive immune response in this example; and finally, HIV infection with the accompanying low grade chronic inflammation in the CNS in some patients, which may be an explanation for the presence of cognitive disorders, even in some well-treated HIV-infected patients. We also emphasize that, although the immune response is generally associated with viral replication control and limited cellular death, an exaggerated inflammatory reaction can lead to tissue damage and can be detrimental for the host, a feature of the immune reconstitution inflammatory syndrome (IRIS). We will briefly address the indication of steroids in this situation.
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Affiliation(s)
- M Spatola
- Service of Neurology, BH.10.131, Bugnon 44, 1010 Lausanne, Switzerland
| | - R A Du Pasquier
- Service of Neurology, BH.10.131, Bugnon 44, 1010 Lausanne, Switzerland; Laboratory of neuro-immunology, Centre of clinical neurosciences, Department of Clinical Neurosciences, University Hospital of Lausanne (CHUV), rue du Bugnon 46, 1011 Lausanne, Switzerland.
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Abdel Razek AAK, Alvarez H, Bagg S, Refaat S, Castillo M. Imaging Spectrum of CNS Vasculitis. Radiographics 2014; 34:873-894. [DOI: 10.1148/rg.344135028] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Abstract
The limbic system is predominantly involved in memory and emotional output. Its 2 principle components are the hippocampus (involved in memory as part of the Papez circuit) and the amygdala (involved in emotional responses, memories and drives). The principle clinical manifestations of limbic disease are epilepsy, confusional states, and cognitive impairment. The connections of the limbic system are widespread and are now becoming visible on diffusion tensor imaging. Many different diseases may affect the limbic system. An appreciation of its functional anatomy along with its white matter tract connections improves assessment of infiltrative disease in particular. Small lesions in the Papez circuit may have devastating neuropsychological consequences. An active search strategy based on the knowledge presented in this paper will increase the likelihood of making an accurate diagnosis for patients affected by these conditions.
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Affiliation(s)
- Karl-Olof Lövblad
- Division of Diagnostic and Interventional Neuroradiology, University Hospitals and Geneva University Medical School, Geneva Switzerland.
| | - Karl Schaller
- Division of Neurosurgery, University Hospitals and Geneva University Medical School, Geneva, Switzerland
| | - Maria Isabel Vargas
- Division of Diagnostic and Interventional Neuroradiology, University Hospitals and Geneva University Medical School, Geneva Switzerland
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Abstract
Herpes simplex viruses types 1 and 2 (HSV-1 and HSV-2) are human neurotropic viruses that establish latent infection in dorsal root ganglia (DRG) for the entire life of the host. From the DRG they can reactivate to cause human morbidity and mortality. Although they vary, in part, in the clinical disorders they cause, and in their molecular structure, they share several features that govern the biology of their infection of the human nervous system. HSV-1 is the causative agent of encephalitis, corneal blindness, and several peripheral nervous system disorders; HSV-2 is responsible for meningoencephalitis in neonates and meningitis in adults. The biology of their ability to establish latency, maintain it for the entire life of the host, reactivate, and cause primary and recurrent disease is being studied in animal models and in humans. This review covers recent advances in understanding the biology and pathogenesis of HSV-related disease.
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Affiliation(s)
- Israel Steiner
- Department of Neurology, Rabin Medical Center, Beilinson Campus, 49100, Petach Tikva, Israel,
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40
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Hofert SM, Burke MG. Nothing is simple about a complex febrile seizure: looking beyond fever as a cause for seizures in children. Hosp Pediatr 2014; 4:181-187. [PMID: 24785563 DOI: 10.1542/hpeds.2013-0098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Sheila M Hofert
- Department of Pediatrics, St Agnes Hospital, Baltimore, Maryland; and
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41
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Affiliation(s)
- James F Bale
- Departments of Pediatrics and Neurology, The University of Utah School of Medicine, Salt Lake City, UT, USA.
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Thakur KT, Motta M, Asemota AO, Kirsch HL, Benavides DR, Schneider EB, McArthur JC, Geocadin RG, Venkatesan A. Predictors of outcome in acute encephalitis. Neurology 2013; 81:793-800. [PMID: 23892708 DOI: 10.1212/wnl.0b013e3182a2cc6d] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To investigate predictors of outcome in patients with all-cause encephalitis receiving care in the intensive care unit. METHODS A retrospective analysis of encephalitis cases at The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center was performed. Using multivariate logistic regression analysis, we examined mortality and predictors of good outcome (defined as modified Rankin Scale scores of 1-3) and poor outcome (scores 4 and 5) in those surviving to hospital discharge. RESULTS In our cohort of 103 patients, the median age was 52 years (interquartile range 26), 52 patients (50.49%) were male, 28 patients (27.18%) had viral encephalitis, 19 (18.45%) developed status epilepticus (SE), 15 (14.56%) had cerebral edema, and 19 (18.45%) died. In our multivariate logistic regression analysis, death was associated with cerebral edema (odds ratio [OR] 18.06, 95% confidence interval [CI] 3.14-103.92), SE (OR 8.16, 95% CI 1.55-43.10), and thrombocytopenia (OR 6.28, 95% CI 1.41-28.03). Endotracheal intubation requirement with ventilator support was highly correlated with death (95%). In addition, in those patients who survived, viral, nonviral, and unknown causes of encephalitis were less likely to have a poor outcome at hospital discharge compared with an autoimmune etiology (viral encephalitis: OR 0.09, 95% CI 0.01-0.57; nonviral encephalitis: OR 0.02, 95% CI 0.01-0.31; unknown etiology: OR 0.18, 95% CI 0.04-0.91). CONCLUSIONS Our study suggests that predictors of death in patients with encephalitis comprise potentially reversible conditions including cerebral edema, SE, and thrombocytopenia. Further prospective studies are needed to determine whether aggressive management of these complications in patients with encephalitis improves outcome.
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Affiliation(s)
- Kiran T Thakur
- Johns Hopkins Encephalitis Center, Department of Neurology, The Johns Hopkins University School of Medicine, The Johns Hopkins University, Baltimore, MD, USA
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Aznar Laín G, Dellatolas G, Eisermann M, Boddaert N, Chiron C, Bulteau C, Monteiro JP, An I, Pédespan JM, Cancès C, Peudenier S, Barthez MA, Milh M, Dorfmuller G, Héron B, Nabbout R, Grevent D, Dulac O. Children often present with infantile spasms after herpetic encephalitis. Epilepsia 2013; 54:1571-6. [PMID: 23815601 DOI: 10.1111/epi.12258] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine what epilepsy types occur after herpetic encephalitis and what are the determinant factors for subsequent infantile spasms. METHODS We analyzed retrospectively the clinical history of 22 patients, referred to Necker and Saint Vincent de Paul Hospitals (Paris) through the French pediatric epilepsy network from March 1986 to April 2010 and who developed epilepsy some months after herpetic encephalitis. We focused on seizure semiology with video-electroencephalography (EEG) recording, and on neuroradiology and epilepsy follow-up. KEY FINDINGS Fourteen patients developed pharmacoresistant spasms, and eight developed focal epilepsy, but none had both. The patients who developed spasms were more frequently younger than 30 months at age of onset of epilepsy and had herpetic encephalitis earlier (mean 10.6 months of age) than those who developed focal epilepsy (mean 59.7 and 39.6 months, respectively). Epilepsy follow-up was similar in both groups (8.5 and 11 years, respectively). We found 26 affected cerebral areas; none alone was related to the development of epileptic spasms. SIGNIFICANCE Risk factors to develop epileptic spasms were to have had herpetic encephalitis early (mean 10 months); to be significantly younger at onset of epilepsy (mean 22.1 months); and to have cerebral lesions involving the insula, the hippocampus, and the temporal pole.
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Affiliation(s)
- Gemma Aznar Laín
- Pediatric Neurology, Pediatric Department, Del Mar Hospital, Autonomous University of Barcelona, Barcelona, Spain.
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Venturini E, Chiappini E, Fonda C, Galli L, de Martino M. Herpes simplex encephalitis with occipital localization in an infant: a different route of entry in the brain system? Pediatr Neurol 2013; 48:463-5. [PMID: 23668872 DOI: 10.1016/j.pediatrneurol.2013.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 02/24/2013] [Indexed: 11/19/2022]
Abstract
Herpes simplex encephalitis classically involves the periventricular white matter in infants and the mesial temporal lobes, inferior frontal lobes, and insula in older children and adults. However, the increasing use of polymerase chain reaction to detect viral DNA in the cerebrospinal fluid has allowed the expansion of the spectrum of radiologic findings possibly associated with herpes simplex encephalitis. This study presents a rare case of a previously healthy infant with herpes simplex encephalitis with occipital involvement and permanent visual impairment. Possible pathogenic mechanisms are discussed.
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Affiliation(s)
- Elisabetta Venturini
- Department of Sciences for Woman and Child's Health, University of Florence, Anna Meyer, Children's University Hospital, Florence, Italy
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46
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Engelmann I, Nasser H, Belmiloudi S, Le Guern R, Dewilde A, Vallée L, Hober D. Clinically severe Epstein-Barr virus encephalitis with mild cerebrospinal fluid abnormalities in an immunocompetent adolescent: a case report. Diagn Microbiol Infect Dis 2013; 76:232-4. [DOI: 10.1016/j.diagmicrobio.2013.02.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 01/30/2013] [Accepted: 02/19/2013] [Indexed: 11/26/2022]
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Benseler S, Pohl D. Childhood central nervous system vasculitis. HANDBOOK OF CLINICAL NEUROLOGY 2013; 112:1065-78. [DOI: 10.1016/b978-0-444-52910-7.00024-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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An Encephalitis Primer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2013; 764:133-40. [DOI: 10.1007/978-1-4614-4726-9_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Vázquez E, Delgado I, Sánchez-Montañez A, Barber I, Sánchez-Toledo J, Enríquez G. Side effects of oncologic therapies in the pediatric central nervous system: update on neuroimaging findings. Radiographics 2012; 31:1123-39. [PMID: 21768243 DOI: 10.1148/rg.314105180] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The need for early, accurate diagnosis of central nervous system (CNS) complications occurring during and after pediatric cancer treatment is growing because of the improvement in overall survival rates related to innovative and aggressive oncologic therapies. An elevated degree of suspicion is needed to recognize the radiologic features of these CNS complications. Radiologists need familiarity with the early and late side effects of cancer therapy in the pediatric CNS (eg, toxic effects, infection, endocrine or sensory dysfunction, neuropsychologic impairment, second malignancies), in order to accelerate the imaging diagnosis and minimize as much as possible the associated morbidity. Acquisition of knowledge about these complications will enable the development of more appropriate therapeutic trials and more effective patient surveillance and will lead to an improved quality of life by decreasing the long-term sequelae in survivors.
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Affiliation(s)
- Elida Vázquez
- Department of Pediatric Radiology and Pediatric Oncohematology, Universidad Autónoma de Barcelona, Barcelona, Spain.
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50
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Nickerson JP, Richner B, Santy K, Lequin MH, Poretti A, Filippi CG, Huisman TAGM. Neuroimaging of pediatric intracranial infection--part 2: TORCH, viral, fungal, and parasitic infections. J Neuroimaging 2012; 22:e52-63. [PMID: 22309611 DOI: 10.1111/j.1552-6569.2011.00699.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
In the second half of this 2-part review, the neuroimaging features of the most common viral, fungal, and parasitic infections of the pediatric central nervous system are discussed. Brief discussions of epidemiology and pathophysiology will be followed by a review of the imaging findings and potential differential considerations.
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Affiliation(s)
- Joshua P Nickerson
- Divisions of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD, USA
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