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Li X, Li J, Wu G, Wang M, Jing Z. Detection of Japanese Encephalitis by Metagenomic Next-Generation Sequencing of Cerebrospinal Fluid: A Case Report and Literature Review. Front Cell Neurosci 2022; 16:856512. [PMID: 35250491 PMCID: PMC8892252 DOI: 10.3389/fncel.2022.856512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/25/2022] [Indexed: 12/28/2022] Open
Abstract
Japanese encephalitis (JE) is an acute viral central nervous system disease, although less than 1% of patients infected with Japanese encephalitis virus (JEV) result in JE, which has an extremely poor prognosis. The Routine detection methods for JEV are time-consuming or limited by hospital conditions, therefore, need the quicker and sensitive techniques to detect JEV. Here, we reported a 14-year-old female who was admitted to our hospital with a severe fever, progressively headache and unconsciousness. Based on the clinical presentation, Preliminary diagnosis on admission indicated central nervous system infection of suspected viral meningoencephalitis or autoimmune encephalitis. The patient's symptoms were unrelieved after being treated with empiric antiviral therapy. Magnetic resonance imaging (MRI) showed that the lesions were located in the bilateral thalamus, head of caudate nucleus, and right lenticular nucleus, so we had to consider the possibility of Flaviviruses infection. We sent the cerebrospinal fluid (CSF) for metagenomic next-generation sequencing (mNGS) immediately, subsequent result suggested the infection caused by JEV. Two days later the results of the serum agglutination test confirmed that virus immunoglobulin M antibody positive. After a week treatment with intravenous immunoglobulin (IVIG), meanwhile, the lumbar puncture was used to check the pressure and various indicators of the CSF again to evaluate the treatment effect, An decrease in the number of WBC indicates, protein and unique RNA reads that the previous experimental treatment was effective, accompany by temperature and consciousness of the patient was normalized. Two weeks after admission, the patient was transferred to the rehabilitation hospital, MR showed the lesions had disappeared completely after 2 months of follow-up. We believed that mNGS may be an effective method for rapid identification of JE.
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Affiliation(s)
- Xin Li
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
| | - Jing Li
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
| | - Guode Wu
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
| | - Manxia Wang
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China
- *Correspondence: Manxia Wang
| | - Zhang Jing
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
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2
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Clinical applications of diffusion-weighted sequence in brain imaging: beyond stroke. Neuroradiology 2021; 64:15-30. [PMID: 34596716 PMCID: PMC8484843 DOI: 10.1007/s00234-021-02819-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/10/2021] [Indexed: 11/20/2022]
Abstract
Diffusion-weighted imaging (DWI) is a well-established MRI sequence for diagnosing early stroke and provides therapeutic implications. However, DWI yields pertinent information in various other brain pathologies and helps establish a specific diagnosis and management of other central nervous system disorders. Some of these conditions can present with acute changes in neurological status and mimic stroke. This review will focus briefly on diffusion imaging techniques, followed by a more comprehensive description of the utility of DWI in common neurological entities beyond stroke.
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3
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MRI Spectrum of Japanese Encephalitis in Northeast India: A Cross-Sectional Study. J Neurosci Rural Pract 2021; 12:281-289. [PMID: 33935446 PMCID: PMC8079177 DOI: 10.1055/s-0041-1722820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective
Japanese encephalitis (JE) is an arthropod-borne flavivirus infection having high mortality and morbidity. This study was performed to evaluate the conventional magnetic resonance imaging (MRI) findings in JE and to find out any difference between pediatric and adult JE.
Materials and Methods
This retrospective study was performed on serologically positive 54 JE patients presented to a tertiary care hospital with acute encephalitic symptoms between April 2016 and October 2019. Relevant neurological examination, cerebrospinal fluid analysis, and MRI scan of the brain were performed.
Results
Fifty-four JE patients (
n
= 31 males and
n
= 23 females) having 32 pediatric and 22 adult JE were included in the study sample. Group 1 JE (
n
= 16) patients had encephalitic symptoms with duration less than 15 days up to the day of MRI scan and group 2 JE (
n
= 38) had symptoms more than 15 days. Group 1 JE had mean apparent diffusion coefficient (ADC) value of 0.563 ± 0.109 (standard deviation [SD]) × 10
–3
mm
2
/sec and group 2 JE had 1.095 ± 0.206 (SD) × 10
–3
mm
2
/sec. The mean ADC value of pediatric JE was 0.907 ± 0.336 (SD) × 10
–3
mm
2
/sec and adult JE was 0.982 ± 0.253 (SD) × 10
–3
mm
2
/sec.
Conclusion
The majority of the JE patient shows abnormal signal alterations in bilateral thalami and substantia nigra. Diffusion-weighted imaging with ADC mapping helps in evaluating the stage of the JE. No statistical significance of the various conventional MRI findings was found between the pediatric JE and adult JE.
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Arahata Y, Fujii K, Nishimura T, Uchida T, Kitazawa K, Honda A. Longitudinal magnetic resonance imaging changes in Japanese encephalitis. Brain Dev 2019; 41:731-734. [PMID: 31003834 DOI: 10.1016/j.braindev.2019.04.005] [Citation(s) in RCA: 4] [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: 11/20/2018] [Revised: 04/03/2019] [Accepted: 04/09/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Japanese encephalitis is a flavivirus that can cause pandemic encephalitis, and is prevalent in Southeast Asia and Australia. Brain images of patients with Japanese encephalitis are characterized by thalamic lesions, distinct from those seen in viral encephalopathies caused by the herpes simplex virus and West Nile virus. AIM Herein, we describe for the first time a time-dependent magnetic resonance imaging pattern in Japanese encephalitis in a 10-month-old Japanese boy. CASE The patient was a previously healthy 10-month-old Japanese boy, who exhibited acute-onset flaccid tetraplegia and loss of tendon reflexes. RESULTS Brain MRI showed characteristic thalamic changes on diffusion weighted images from spotty to uniform and from the left to the right side, associated with low apparent diffusion coefficient maps. These images suggest that the Japanese encephalitis virus may first affect the unilateral thalamus, possibly expanding to the other side, with characteristic patterns changing from spotty to uniform in a manner consistent with the presentation of cytotoxic edema. CONCLUSION This report first showed longitudinal magnetic resonance changes in Japanese encephalitis, which may help in accurate diagnosis and in discrimination from other etiologies.
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Affiliation(s)
- Yukie Arahata
- Department of Pediatrics, Asahi General Hospital, Chiba, Japan
| | - Katsunori Fujii
- Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan.
| | | | - Tomoko Uchida
- Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan
| | | | - Akihito Honda
- Department of Pediatrics, Asahi General Hospital, Chiba, Japan
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5
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Imaging the Unconscious “Found Down” Patient in the Emergency Department. Neuroimaging Clin N Am 2018; 28:435-451. [DOI: 10.1016/j.nic.2018.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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6
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Jugpal TS, Dixit R, Garg A, Gupta S, Jain V, Patel R, Agarwal S. Spectrum of findings on magnetic resonance imaging of the brain in patients with neurological manifestations of dengue fever. Radiol Bras 2017; 50:285-290. [PMID: 29085161 PMCID: PMC5656068 DOI: 10.1590/0100-3984.2016.0048] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To describe the spectrum of magnetic resonance imaging (MRI) findings in
patients with neurological manifestations of dengue. Materials and Methods We included nine patients with dengue fever (three females and six males; age
range, 9–30 years), all of whom presented with neurological manifestations.
The MRI examinations, performed in 1.5 T or 3 T scanners, included
T1-weighted, T2-weighted, and fluid-attenuated inversion recovery (FLAIR)
sequences. Diffusion-weighted imaging with apparent diffusion coefficient
mapping was also employed. Fast low-angle shot and susceptibility-weighted
gradient-recalled echo sequences, as well as contrast-enhanced T1-weighted
scans, were also obtained in order to assess parenchymal enhancement. MRI
scans were analyzed for lesion distribution and imaging features. Results All patients showed areas of altered signal intensity that appeared as
hyperintensity on T2-weighted and FLAIR sequences. The most commonly
affected site was the basal ganglia-thalamus complex. Other affected sites
were the cerebellum, cerebral cortex, white matter, and brainstem. In all
cases, we observed patchy areas of restricted diffusion and focal areas of
hemorrhage. Conclusion Dengue encephalitis commonly affects the basal ganglia, thalamus, cerebellum,
cerebral cortex, and white matter. Therefore, MRI should be an indispensable
part of the evaluation of patients with neurological complications of dengue
fever.
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Affiliation(s)
| | - Rashmi Dixit
- MD, Department of Diagnostic Radiology, Maulana Azad Medical College, New Delhi, India
| | - Anju Garg
- MD, Department of Diagnostic Radiology, Maulana Azad Medical College, New Delhi, India
| | - Swati Gupta
- MD, Department of Diagnostic Radiology, Maulana Azad Medical College, New Delhi, India
| | - Virendra Jain
- MD, Department of Diagnostic Radiology, Maulana Azad Medical College, New Delhi, India
| | - Ronak Patel
- MD, Department of Diagnostic Radiology, Maulana Azad Medical College, New Delhi, India
| | - Shobhit Agarwal
- MD, Department of General Medicine, Maulana Azad Medical College, New Delhi, India
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7
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Koeller KK, Shih RY. Viral and Prion Infections of the Central Nervous System: Radiologic-Pathologic Correlation: From the Radiologic Pathology Archives. Radiographics 2017; 37:199-233. [PMID: 28076019 DOI: 10.1148/rg.2017160149] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Viral infections of the central nervous system (CNS) range in clinical severity, with the most severe proving fatal within a matter of days. Some of the more than 100 different viruses known to affect the brain and spinal cord are neurotropic with a predilection for producing CNS infection. The host response to viral infection of the CNS is responsible for the pathophysiology and imaging findings seen in affected patients. Viral CNS infections can take the form of meningitis, encephalitis, encephalomyelitis, or, when involving the spinal cord and nerve roots, encephalomyeloradiculitis. In 1982, an infectious particle termed a prion that lacked nucleic acid and therefore was not a virus was reported to produce the fatal neurodegenerative disease Creutzfeldt-Jakob disease and related disorders. These prion diseases produce characteristic neuroimaging findings that are distinct from those seen in most viral infections. The clinical and imaging findings associated with viral CNS infection are often nonspecific, with microbiologic analysis of cerebrospinal fluid the most useful single test allowing for diagnosis of a specific viral infection. This review details the spectrum of viral CNS infections and uses case material from the archives of the American Institute for Radiologic Pathology, with a focus on the specific clinical characteristics and magnetic resonance imaging features seen in these infections. Where possible, the imaging features that allow distinction of these infections from other CNS inflammatory conditions are highlighted.
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Affiliation(s)
- Kelly K Koeller
- From the Department of Neuroradiology, American Institute for Radiologic Pathology, Silver Spring, Md (K.K.K., R.Y.S.); Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (K.K.K.); Uniformed Services University of the Health Sciences, Bethesda, Md (R.Y.S.); and Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (R.Y.S.)
| | - Robert Y Shih
- From the Department of Neuroradiology, American Institute for Radiologic Pathology, Silver Spring, Md (K.K.K., R.Y.S.); Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (K.K.K.); Uniformed Services University of the Health Sciences, Bethesda, Md (R.Y.S.); and Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (R.Y.S.)
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8
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Bookstaver PB, Mohorn PL, Shah A, Tesh LD, Quidley AM, Kothari R, Bland CM, Weissman S. Management of Viral Central Nervous System Infections: A Primer for Clinicians. J Cent Nerv Syst Dis 2017; 9:1179573517703342. [PMID: 28579869 PMCID: PMC5415352 DOI: 10.1177/1179573517703342] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 01/22/2017] [Indexed: 12/11/2022] Open
Abstract
Viruses are a common cause of central nervous system (CNS) infections with many host, agent, and environmental factors influencing the expression of viral diseases. Viruses can be responsible for CNS disease through a variety of mechanisms including direct infection and replication within the CNS resulting in encephalitis, infection limited to the meninges, or immune-related processes such as acute disseminated encephalomyelitis. Common pathogens including herpes simplex virus, varicella zoster, and enterovirus are responsible for the greatest number of cases in immunocompetent hosts. Other herpes viruses (eg, cytomegalovirus, John Cunningham virus) are more common in immunocompromised hosts. Arboviruses such as Japanese encephalitis virus and Zika virus are important pathogens globally, but the prevalence varies significantly by geographic region and often season. Early diagnosis from radiographic evidence and molecular (eg, rapid) diagnostics is important for targeted therapy. Antivirals may be used effectively against some pathogens, although several viruses have no effective treatment. This article provides a review of epidemiology, diagnostics, and management of common viral pathogens in CNS disease.
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Affiliation(s)
- P Brandon Bookstaver
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Phillip L Mohorn
- Department of Pharmacy, Spartanburg Medical Center, Spartanburg Regional Healthcare System, Spartanburg, SC, USA
| | - Ansal Shah
- Division of Infectious Diseases, School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Lauren D Tesh
- Division of Advisory Committee and Consultant Management, Office of Executive Programs, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - April M Quidley
- Department of Pharmacy Services, Vidant Medical Center, Greenville, NC, USA
| | - Ravish Kothari
- Department of Neurology, University of South Carolina/Palmetto Medical Group, Columbia, SC, USA
| | - Christopher M Bland
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Savannah, GA, USA
| | - Sharon Weissman
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC, USA
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9
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Katirag A, Beker-Acay M, Unlu E, Demirbas H, Demirturk N. Apparent Diffusion Coefficient analysis of encephalitis: A comparative study with topographic evaluation and conventional MRI findings. Pak J Med Sci 2016; 32:725-30. [PMID: 27375722 PMCID: PMC4928431 DOI: 10.12669/pjms.323.10030] [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] [Indexed: 12/02/2022] Open
Abstract
Objective: Our purpose was to reveal the efficiency of diffusion weighted imaging (DWI) in the diagnosis of encephalitis, and to determine the relation between the apparent diffusion coefficient (ADC) values, the onset of the clinical symptoms, and the lesion extent. Methods: Conventional magnetic resonance imaging (MRI) was performed in 17 patients with encephalitis diagnosed on the basis of laboratory, clinical and radiologic findings during 2009 and 2015. Based on the duration between the onset of the symptoms and the brain MRI findings, the patients were divided into three groups. ADC values of the encephalitis lesion, the lesions’ topographic analysis score, deep gray matter involvement, patients’ clinical situation and the duration of the arrival to the clinic was examined. Results: Mean ADC values were 0,988±0,335 x10-3 mm2/s in group I (0-2 days), 1,045±0,347 x10-3 mm2/s in Group-II (3-7 days), 1,451±0,225 x10-3 mm2/s in Group-III (8 days and over). The relation between the ADC values and the duration of the arrival, topographic analysis score, the relation between the patients’ clinical situation and the deep gray matter involvement were found to be statistically significant. The deep gray matter involvement was demonstrated more clearly by FLAIR images when compared with DWI. Conclusion: Conventional MRI sequences may be insufficient in showing the encephalitis lesion. DWI must be added to the imaging modalities immediately in the cases suspected of having encephalitis.
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Affiliation(s)
- Ahmet Katirag
- Ahmet Katirag, MD. Resident Assistant, Department of Radiology, Afyon Kocatepe University Faculty of Medicine, Afyonkarahisar, Turkey
| | - Mehtap Beker-Acay
- Mehtap Beker-Acay, MD. Assistant Professor, Department of Radiology, Afyon Kocatepe University Faculty of Medicine, Afyonkarahisar, Turkey
| | - Ebru Unlu
- Ebru Unlu, MD. Assistant Professor, Department of Radiology, Afyon Kocatepe University Faculty of Medicine, Afyonkarahisar, Turkey
| | - Hayri Demirbas
- Hayri Demirbas M.D. Assistant Professor, Department of Neurology, Afyon Kocatepe University Faculty of Medicine, Afyonkarahisar, Turkey
| | - Nese Demirturk
- Nese Demirturk MD. Associate Professor, Department of Infectious Diseases, Afyon Kocatepe University Faculty of Medicine, Afyonkarahisar, Turkey
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10
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Gupta K, Banerjee A, Saggar K, Ahluwalia A, Saggar K. A prospective study of magnetic resonance imaging patterns of central nervous system infections in pediatric age group and young adults and their clinico-biochemical correlation. J Pediatr Neurosci 2016; 11:46-51. [PMID: 27195033 PMCID: PMC4862288 DOI: 10.4103/1817-1745.181244] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Infections of the central nervous system (CNS) are common and routinely encountered. Our aim was to evaluate the neuroimaging features of the various infections of the CNS so as to differentiate them from tumoral, vascular, and other entities that warrant a different line of therapy. Aims: Our aim was to analyze the biochemical and magnetic resonance imaging (MRI) features in CNS infections. Settings and Design: This was a longitudinal, prospective study over a period of 1½ years. Subjects and Methods: We studied cerebrospinal fluid (CSF) findings and MRI patterns in 27 patients of 0–20 years age group with clinical features of CNS infections. MRI was performed on MAGNETOM Avanto 18 Channel 1.5 Tesla MR machine by Siemens India Ltd. The MRI protocol consisted of diffusion-weighted and apparent diffusion coefficient imaging, turbo spin echo T2-weighted, spin echo T1-weighted, fluid-attenuated inversion recovery (FLAIR), and gradient-echo in axial, FLAIR in coronal, and T2-weighted in sagittal plane. Contrast-enhanced T1-weighted sequence and MR spectroscopy were done whenever indicated. Results and Conclusions: We found that most of the children belong to 1–10 years age group. Fungal infections were uncommon, mean CSF adenosine deaminase values specific for tuberculosis and mean CSF glucose-lowered in pyogenic. Hemorrhagic involvement of thalamus with/without basal ganglia and brainstem involvement may indicate Japanese encephalitis or dengue encephalitis. Diffusion restriction or hemorrhage in not expected in the brainstem afflicted lesions of rabies. Congenital cytomegalovirus can cause cortical malformations. T1 hyperintensities with diffusion restriction may represent viral encephalitis. Lesions of acute disseminated encephalomyelitis (ADEM) may mimic viral encephalitis. Leptomeningeal enhancement is predominant in pyogenic meningitis. Basilar meningitis in the presence of tuberculomas is highly sensitive and specific for tuberculosis.
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Affiliation(s)
- Kamini Gupta
- Department of Radiodiagnosis, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Avik Banerjee
- Department of Radiodiagnosis, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Kavita Saggar
- Department of Radiodiagnosis, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Archana Ahluwalia
- Department of Radiodiagnosis, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Karan Saggar
- Department of Dentistry, Baba Jaswant Singh Dental College, Ludhiana, Punjab, India
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11
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Wong AM, Lin JJ, Toh CH, Bilaniuk LT, Zimmerman RA, Chang YC, Lin KL, Wang HS. Childhood encephalitis: relationship between diffusion abnormalities and clinical outcome. Neuroradiology 2014; 57:55-62. [DOI: 10.1007/s00234-014-1449-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 09/29/2014] [Indexed: 12/01/2022]
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12
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Saini J, Gupta RK, Jain KK. Intracranial infections: key neuroimaging findings. Semin Roentgenol 2014; 49:86-98. [PMID: 24342678 DOI: 10.1053/j.ro.2013.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Rakesh K Gupta
- Department of Radiology and Imaging, Fortis Memorial Research Institute, Gurgaon, Haryana, India.
| | - Krishan K Jain
- Department of Radiology and Imaging, Fortis Memorial Research Institute, Gurgaon, Haryana, India
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13
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Mahan M, Karl M, Gordon S. Neuroimaging of viral infections of the central nervous system. HANDBOOK OF CLINICAL NEUROLOGY 2014; 123:149-73. [PMID: 25015484 DOI: 10.1016/b978-0-444-53488-0.00006-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Mathur Mahan
- Department of Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Muchantef Karl
- Department of Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Sze Gordon
- Department of Radiology, Yale University School of Medicine, New Haven, CT, USA.
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14
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Degnan AJ, Levy LM. Neuroimaging of rapidly progressive dementias, part 2: prion, inflammatory, neoplastic, and other etiologies. AJNR Am J Neuroradiol 2013; 35:424-31. [PMID: 23413251 DOI: 10.3174/ajnr.a3455] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Most dementias begin insidiously, developing slowly and generally occurring in the elderly age group. The so-called rapidly progressive dementias constitute a different, diverse collection of conditions, many of which are reversible or treatable. For this reason, accurate identification and assessment of acute and subacute forms of dementia are critical to effective treatment; neuroimaging aids greatly in narrowing the diagnosis of these conditions. This second installment of a 2-part review of rapidly progressive dementias examines the use of imaging in an assortment of other etiologies in the differential diagnosis, from prion disease and neoplastic-related conditions to rare metabolic and other conditions such as Wernicke encephalopathy. In these clinical conditions, MR imaging has the potential to narrow this broad differential diagnosis and, at times, can definitively aid in the diagnosis of certain conditions on the basis of typical imaging patterns.
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Affiliation(s)
- A J Degnan
- From the University of Pittsburgh Medical Center (A.J.D.), Pittsburgh, Pennsylvania
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15
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16
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Chen HW, Ding LW, Lai CC, Tseng TK, Liu WL. Japanese viral encephalitis mimicking stroke with an initial manifestation of hemiplegia. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2012; 45:465-7. [DOI: 10.1016/j.jmii.2011.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 05/15/2010] [Accepted: 07/20/2010] [Indexed: 11/27/2022]
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17
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Kawamura N, Kizawa M, Ueda A, Niimi Y, Mutoh T. An update on diagnostic imaging studies for viral encephalitis. Future Virol 2012. [DOI: 10.2217/fvl.12.75] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Viral encephalitis is still a life-threatening disease occurring at any age. It is critical to make a rapid and correct diagnosis for a better outcome of the disease. Accumulating evidence has suggested that MRI is a powerful tool for the detection of any lesion of the CNS caused by viral infections and helps to initiate the timely treatment. In this review, we summarize the current understanding of MRI findings of viral encephalitis, especially related to HSV, HIV, varicella zoster, Japanese encephalitis, John Cunningham, and influenza viruses. With these considerations, we learnt that the inclusion of diffusion-weighted image sequences on routine MRI examination would have a significant value in detecting the pathologic changes that occur following viral invasion of the CNS.
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Affiliation(s)
- Naoki Kawamura
- Department of Neurology, Fujita Health University School of Medicine, Aichi, Japan
| | - Madoka Kizawa
- Department of Neurology, Fujita Health University School of Medicine, Aichi, Japan
| | - Akihiro Ueda
- Department of Neurology, Fujita Health University School of Medicine, Aichi, Japan
| | - Yoshiki Niimi
- Department of Neurology, Fujita Health University School of Medicine, Aichi, Japan
| | - Tatsuro Mutoh
- Department of Neurology, Fujita Health University School of Medicine, Aichi, Japan
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18
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Jia M, Xiong N, Huang J, Wang Y, Zhang X, Zhang Z, Cao X, Lin Z, Wang T. Japanese encephalitis accompanied by cerebral venous sinus thrombosis: a case report. BMC Neurol 2012; 12:43. [PMID: 22712500 PMCID: PMC3437198 DOI: 10.1186/1471-2377-12-43] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 06/19/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebral venous sinus thrombosis (CVST) is a relatively rare cerebrovascular condition which accounts for 0.5% of all strokes. Risk of CVST has been documented in patients with numerous conditions including central nervous system infections, however, Japanese encephalitis (JE, epidemic encephalitis type B) with CVST has not been reported previously. CASE PRESENTATION Here, we present a case of JE with CVST in a 17-year-old man. On admission, the patient was initially diagnosed as intracranial infection, and soon after, brain magnetic resonance (MR) imaging (MRI) and MR Venography (MRV) confirmed the diagnosis of CVST. Moreover, the blood JE-specific IgM antibody which proved weakly positive at first, turned positive one week later. Consequently, our patient was diagnosed as CVST accompanied by JE. Anticoagulant and anti-infective therapy were initiated, which eventually lead to gradual recovery of the patient. CONCLUSIONS To our knowledge, this is the first case report of CVST associated with JE. MRI and MRV represent a prime method for the diagnosis of CVST, while the positivity of JE virus IgM antibody, especially increased antibody levels within a short period, is of great significance to diagnose JE. The early diagnosis and timely treatment of this potentially lethal condition would improve its prognosis significantly.
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Affiliation(s)
- Min Jia
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan 430022, Hubei, China
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Maia ACM, Guedes BVS, Lucas A, da Rocha AJ. Diffusion MR imaging for monitoring treatment response. Neuroimaging Clin N Am 2011; 21:153-78, viii-ix. [PMID: 21477756 DOI: 10.1016/j.nic.2011.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of this article was to emphasize the use of diffusion-weighted imaging in the diagnosis and follow-up of several major disease contexts, as established in recent literature. In some of these diseases the diffusion changes are correlated with the clinical deficit and are potentially useful for early diagnosis and longitudinal evaluation, as well as in the context of pharmacologic trials. Diffusion magnetic resonance is a major advance in the continuing evolution of MR imaging. It provides contrasts and characterization between tissues at a cellular level that may imply differences in function as well as framework and have contributed to a better understanding of the pathophysiological mechanisms of several diseases.
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Affiliation(s)
- Antonio Carlos Martins Maia
- Section of Neuroradiology, Centro de Medicina Diagnostica Fleury and Santa Casa de Misericordia de São Paulo, R. Cincinato Braga 282, Paraíso, São Paulo, SP, CEP 01333-910, Brazil.
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Hegde AN, Mohan S, Lath N, Lim CCT. Differential diagnosis for bilateral abnormalities of the basal ganglia and thalamus. Radiographics 2011; 31:5-30. [PMID: 21257930 DOI: 10.1148/rg.311105041] [Citation(s) in RCA: 199] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The basal ganglia and thalamus are paired deep gray matter structures that may be involved by a wide variety of disease entities. The basal ganglia are highly metabolically active and are symmetrically affected in toxic poisoning, metabolic abnormalities, and neurodegeneration with brain iron accumulation. Both the basal ganglia and thalamus may be affected by other systemic or metabolic disease, degenerative disease, and vascular conditions. Focal flavivirus infections, toxoplasmosis, and primary central nervous system lymphoma may also involve both deep gray matter structures. The thalamus is more typically affected alone by focal conditions than by systemic disease. Radiologists may detect bilateral abnormalities of the basal ganglia and thalamus in different acute and chronic clinical situations, and although magnetic resonance (MR) imaging is the modality of choice for evaluation, the correct diagnosis can be made only by taking all relevant clinical and laboratory information into account. The neuroimaging diagnosis is influenced not only by detection of specific MR imaging features such as restricted diffusion and the presence of hemorrhage, but also by detection of abnormalities involving other parts of the brain, especially the cerebral cortex, brainstem, and white matter. Judicious use of confirmatory neuroimaging investigations, especially diffusion-weighted imaging, MR angiography, MR venography, and MR spectroscopy during the same examination, may help improve characterization of these abnormalities and help narrow the differential diagnosis.
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Affiliation(s)
- Amogh N Hegde
- Department of Neuroradiology, National Neuroscience Institute, Singapore.
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Abstract
Rabies remains a virtually incurable disease once symptoms develop. Neuroimaging studies demonstrate lesions in the different parts of the neuroaxis, even before brain symptoms are evident. These abnormalities have been detailed in both rabies virus-infected humans and dogs with magnetic resonance imaging (MRI). MRI disturbances were similar in both forms (furious or paralytic) in human rabies; however, they were more pronounced in paralytic than in furious rabies virus-infected dogs in which examination was done early in the disease course. Abnormalities were not confined only to neuronal structures of hippocampus, hypothalamus, basal ganglia, and brain stem but also extended to white matter. The blood-brain barrier (BBB) has been clearly shown to be intact during the time rabies virus-infected patients and dogs remained conscious, whereas leakage was demonstrated as soon as they became comatose. Although the location of MRI abnormalities can help diagnosing rabies, the intensities of signals are usually not very distinct and sometimes not recognizable. Newer techniques and protocols have been developed and utilized, such as diffusion-weighted imaging and diffusion tensor imaging, and the latter provides both qualitative and quantitative data. These techniques have been applied to normal and rabies virus-infected dogs to construct fractional anisotropy and mean diffusivity maps. Results showed clear-cut evidence of BBB intactness with absence of vasogenic brain edema and preservation of most neuronal structures and tracts except at the level of brainstem in paralytic rabies-infected dogs. Neuroimaging is one of the most useful tools for the in vivo study of central nervous system infections.
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Misra UK, Kalita J, Phadke RV, Wadwekar V, Boruah DK, Srivastava A, Maurya PK, Bhattacharyya A. Usefulness of various MRI sequences in the diagnosis of viral encephalitis. Acta Trop 2010; 116:206-11. [PMID: 20816658 DOI: 10.1016/j.actatropica.2010.08.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 08/09/2010] [Accepted: 08/11/2010] [Indexed: 11/29/2022]
Abstract
There is paucity of studies regarding the utility of various conventional MRI sequences in the diagnosis of viral encephalitis. The present study evaluates the usefulness of various MRI sequences in acute viral encephalitis. 88 consecutive viral encephalitis patients, aged 2-72 years were subjected to clinical evaluation. Consciousness was assessed by Glasgow Coma Scale (GCS). Serum or cerebrospinal fluid (CSF) was analyzed for dengue, Japanese encephalitis (JE), herpes, measles, echo, coxsackie and polio viruses using ELISA or PCR. Cranial MRI was done and T1, T2, FLAIR and DW images were obtained. The MRI changes were correlated with type of encephalitis and duration of illness. All the patients had altered sensorium and 37 had seizures. 22 patients had JE, 9 had dengue, 8 had herpes simplex encephalitis (HSE), 2 had Epstein-Barr virus encephalitis (EBVE) and 47 had non-specific encephalitis. The median duration of MRI study from onset was 10 days. In JE (20/22), HSE (8/8), and EBVE (2/2), MRI abnormalities were more common compared to dengue (2/9) and non-specific (20/47) encephalitis. The MRI abnormalities were more common in FLAIR (57.1%) compared to T2 (52.9%), DWI (38.1%) and T1 (19.3%) sequences. The mean ADC value in JE patients was lower (974.0±110.85×10⁻⁶ mm²/s) than HSE (1024.33±485.76×10⁻⁶ mm²/s). Additional MRI lesions were seen in 12.6% cases on FLAIR sequence. FLAIR and T2 sequences were more sensitive in revealing abnormalities in viral encephalitis.
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Affiliation(s)
- U K Misra
- Department of Neurology, Sanjay Gandhi PGIMS, Lucknow, India
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Diffusion-weighted imaging and apparent diffusion coefficient evaluation of herpes simplex encephalitis and Japanese encephalitis. J Neurol Sci 2009; 287:221-6. [PMID: 19732907 DOI: 10.1016/j.jns.2009.07.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Revised: 07/12/2009] [Accepted: 07/14/2009] [Indexed: 11/23/2022]
Abstract
PURPOSE The aim of the study was to evaluate (a) the role of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values in differentiating necrotising herpes simplex encephalitis (HSE) and non-necrotising Japanese encephalitis (JE) and (b) to correlate the ADC values with the duration of illness. MATERIALS AND METHODS Forty-five confirmed cases of encephalitis (38 patients with JE and 7 patients with HSE) underwent MR imaging. IgM antibody capture enzyme-linked immunosorbent assay (IgM MAC-ELISA) and polymerase chain reaction (PCR) tests were performed in cerebral spinal fluid (CSF) sample to confirm the diagnosis of JE and HSE respectively. MRI findings were recorded in terms of site of involvement, extent of lesions, visibility of each lesion on T2W, DWI and FLAIR sequences and ADC calculations. To observe the changes in ADC with duration of illness, patients with JE and HSE were regrouped on the basis of time since clinical presentation. Mean of the ADC value in each patient was noted and subjected for statistical analysis. RESULTS In HSE lesions there was a significant restricted diffusion with low average ADC values observed in acute stage and facilitated diffusion with high average ADC values observed in chronic stage. Whereas JE lesions did not show restricted diffusion and significant low ADC values in acute stage, though facilitated diffusion and high ADC values were observed in chronic stage. CONCLUSION The diffusion abnormality and conspicuity of lesions on DWI may be different in various acute encephalitis (HSE and JE). The ADC values are different in the acute stages of HSE and JE reflecting the difference in the degree of diffusability of water molecule. These observations may suggest that there may be an abundance of cytotoxic oedema in HSE and paucity of cytotoxic oedema in JE, in acute stage.
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Kumar G, Kalita J, Misra UK. Raised intracranial pressure in acute viral encephalitis. Clin Neurol Neurosurg 2009; 111:399-406. [DOI: 10.1016/j.clineuro.2009.03.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 03/10/2009] [Accepted: 03/11/2009] [Indexed: 12/12/2022]
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Affiliation(s)
- Zoran Rumboldt
- Department of Radiology, Medical University of South Carolina, 169 Ashley Avenue, Charleston, SC 29425, USA.
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Kiroğlu Y, Calli C, Yunten N, Kitis O, Kocaman A, Karabulut N, Isaev H, Yagci B. Diffusion-weighted MR imaging of viral encephalitis. Neuroradiology 2006; 48:875-80. [PMID: 16944118 DOI: 10.1007/s00234-006-0143-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2006] [Accepted: 07/24/2006] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the role of diffusion-weighted imaging (DWI) in the diagnosis of viral encephalitis and its relationship with the stage of the illness. METHODS We performed conventional magnetic resonance imaging (MRI) including T1-W, T2-W and fluid attenuated inversion recovery (FLAIR) sequences and DWI in 18 patients with viral encephalitis diagnosed on the basis of laboratory, clinical and radiologic findings. Based on the qualitative and quantitative comparison of the conventional MRI and DWI, the patients were divided into three groups. Apparent diffusion coefficient (ADC) values of the involved and contralateral normal brain tissues were computed and compared for each group. The degree of correlation between the time (TI) from the onset of neurologic symptoms to the MR examination and ADC values was determined. RESULTS In group I (n=11) DWI was superior to conventional MRI in detecting the encephalitic involved sites and in depicting the borders of the encephalitic lesions. In group II (n=4) DWI was similar to conventional MRI. In group III (n=3) conventional MRI was superior to DWI. Mean ADC values of affected versus contralateral normal brain tissues were 0.458+/-0.161 x 10(-3) versus 0.86+/-0.08 x 10(-3) in group I, 0.670+/-0.142 x 10(-3) versus 0.93+/-0.07 x 10(-3) in group II, and 1.413+/-0.211 x 10(-3) versus 1.05+/-0.06 x 10(-3) in group III. Patients in group I had significantly lower ADC values than those in group II, while patients in group III had the highest ADC values (P<0.05). The ADC values were significantly lower in the affected sites than in the unaffected sites of patients in groups I and II, but were significantly higher in the affected sites than in the unaffected sites of patients in group III (P<0.05). There was an excellent correlation between ADC values and duration of the disease (r=0.874, P=0.01). CONCLUSION DWI is superior to other conventional diagnostic MR sequences in the detection of early viral encephalitic lesions and depiction of the lesion borders and, in combination with other sequences, DWI may contribute to the determination of the disease phase.
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Affiliation(s)
- Yilmaz Kiroğlu
- Department of Radiology, Pamukkale University School of Medicine, TR-20070 Denizli, Turkey.
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Johnsen SD, Bird CR. The thalamus and midbrain in Reye syndrome. Pediatr Neurol 2006; 34:405-7. [PMID: 16648004 DOI: 10.1016/j.pediatrneurol.2005.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2005] [Revised: 08/02/2005] [Accepted: 10/06/2005] [Indexed: 11/16/2022]
Abstract
A previously healthy 5 1/2-year-old male had Reye syndrome. He presented in coma with apnea 1 week after a viral infection and following 2 days of vomiting and progressive obtundation. He was in coma with dystonic posturing and intact brainstem function. Laboratory evaluation revealed initial hypoglycemia, and markedly elevated liver enzymes, prolonged clotting times, and elevated ammonia levels. No underlying metabolic disorder was present, and the patient completely recovered. On a modified diffusion-weighted image magnetic resonance imaging scan, restriction of diffusion in the thalamus and midbrain was observed. While abnormalities of the thalamus and midbrain have previously been reported, this is the first report of diffusion-weighted imaging indicating early impairment of water diffusion, a finding more commonly observed with stroke.
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Affiliation(s)
- Stanley D Johnsen
- Section of Child Neurology, Section of Neuroradiology, Barrow Neurological Institute and Children's Health Center, St. Joseph's Hospital, Phoenix, Arizona 85013, USA.
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