Top

Neuroradiology

Published in:

01-06-2012 | Paediatric Neuroradiology

MRI and associated clinical characteristics of EV71-induced brainstem encephalitis in children with hand–foot–mouth disease

Authors: Hongwu Zeng, Feiqiu Wen, Yungen Gan, Wenxian Huang

Published in: Neuroradiology | Issue 6/2012

Abstract

Introduction

This study was conducted to investigate MRI and associated clinical characteristics of brainstem encephalitis induced by enterovirus 71 (EV71) in children with hand–foot–mouth disease (HFMD).

Methods

We analyzed clinical and imaging data from 42 HFMD cases with EV71-induced brainstem encephalitis. All patients underwent plain and enhanced MRI cranial scans and were placed into one of two groups according to MRI enhancement results, an enhanced group or a nonenhanced group.

Results

Thirty-two cases were positive on MRI exam. The primary location of the lesion for brainstem encephalitis was the dorsal pons and medulla oblongata (32 cases), followed by the cerebellar dentate nucleus (8 cases), midbrain (5 cases), and thalamus (2 cases). Plain T1-weighted images showed isointense or hypointense signals, and T2-weighted images showed isointense and hyperintense signals. Enhanced MRI scans showed that 12 cases had slight to moderate enhancement; 4 of these were normal on plain scan. The time from MRI examination to disease onset was statistically different between the enhanced (n = 12) and nonenhanced (n = 21) groups with a mean of 7.67 days (SD = 1.07) vs 11.95 days (SD = 5.33), respectively. The most common neurological symptoms for brainstem encephalitis were myoclonus and tremor. The greater the area of affected brain, the more severe the clinical symptoms were.

Conclusion

The locations of EV71-induced HFMD-associated brainstem encephalitis lesions are relatively specific. Enhanced MRI scans could also identify the lesions missed by early plain scans. MRI scans can provide important information for clinical evaluation and treatment.

Huang CC, Liu CC, Chang YC et al (1999) Neurologic complications in children with enterovirus 71 infection. N Engl J Med 341:936–942PubMedCrossRef

Chang LY, Lin TY, Hsu KH et al (1999) Clinical features and risk factors of pulmonary oedema after enterovirus-71-related hand, foot, and mouth disease. Lancet 354:1682–1686PubMedCrossRef

AbuBakar S, Chee HY, Al-Kobaisi MF et al (1999) Identification of enterovirus 71 isolates from an outbreak of hand, foot and mouth disease (HFMD) with fatal cases of encephalomyelitis in Malaysia. Virus Res 61:1–9PubMedCrossRef

Shekhar K, Lye MS, Norlijah O et al (1999) Deaths in children during an outbreak of hand, foot and mouth disease in Peninsular Malaysia—clinical and pathological characteristics. Med J Malaysia 60:297–304

Chan LG, Parashar UD, Lye MS et al (2000) Deaths of children during an outbreak of hand, foot, and mouth disease in Sarawak, Malaysia: clinical and pathological characteristics of the disease. For the Outbreak Study Group. Clin Infect Dis 31:678–683PubMedCrossRef

Jang S, Suh SI, Ha SM et al (2011) Enterovirus 71-related encephalomyelitis: usual and unusual magnetic resonance imaging findings. Neuroradiology (in press)

Chan KP, Goh KT, Chong CY et al (2003) Epidemic hand, foot and mouth disease caused by human enterovirus 71, Singapore. Emerg Infect Dis 9:78–85PubMedCrossRef

Wong AM, Simon EM, Zimmerman RA et al (2006) Acute necrotizing encephalopathy of childhood: correlation of MR findings and clinical outcome. AJNR Am J Neuroradiol 27:1919–1923PubMed

Lu CY, Lee CY, Kao CL et al (2002) Incidence and case-fatality rates resulting from the 1998 enterovirus 71 outbreak in Taiwan. J Med Virol 67:217–223PubMedCrossRef

10.

Chen SP, Huang YC, Li WC et al (2010) Comparison of clinical features between coxsackievirus A2 and enterovirus 71 during the enterovirus outbreak in Taiwan, 2008: a children’s hospital experience. J Microbiol Immunol Infect 43:99–104PubMedCrossRef

11.

He YX, Fu D, Cao DZ et al (2009) Critical care and therapy based different illness state of 80 patients with severe hand-foot-and-mouth disease seen in Shenzhen. J Pediatr 47:338–343

12.

Wong KT, Munisamy B, Ong KC et al (2008) The distribution of inflammation and virus in human enterovirus 71 encephalomyelitis suggests possible viral spread by neural pathways. J Neuropathol Exp Neurol 67:162–169PubMedCrossRef

13.

Shieh WJ, Jung SM, Hsueh C et al (2001) Pathologic studies of fatal cases in outbreak of hand, foot, and mouth disease, Taiwan. Emerg Infect Dis 7:146–148PubMedCrossRef

14.

Boping Z, Chenrong L (2009) Enterovirus 71 hand mouth foot disease. The People’s Medical Publishing House, Beijing

15.

Huang CC (2001) Neurologic complications of enterovirus 71 infection in children: lessons from this Taiwan epidemic. Acta Paediatr Taiwan 42:5–7PubMed

16.

Weng KF, Chen LL, Huang PN et al (2010) Neural pathogenesis of enterovirus 71 infection. Microbes Infect 12:505–510PubMedCrossRef

17.

Shen WC, Chiu HH, Chow KC et al (1999) MR imaging findings of enteroviral encephaloymelitis: an outbreak in Taiwan. AJNR Am J Neuroradiol 20:1889–1895PubMed

18.

Lum LC, Wong KT, Lam SK et al (1998) Fatal enterovirus 71 encephalomyelitis. J Pediatr 133:795–798PubMedCrossRef

19.

Wang SM, Lei HY, Huang KJ et al (2003) Pathogenesis of enterovirus 71 brainstem encephalitis in pediatric patients: roles of cytokines and cellular immune activation in patients with pulmonary edema. J Infect Dis 188:564–570PubMedCrossRef

Title: MRI and associated clinical characteristics of EV71-induced brainstem encephalitis in children with hand–foot–mouth disease
Authors: Hongwu Zeng
Feiqiu Wen
Yungen Gan
Wenxian Huang
Publication date: 01-06-2012
Publisher: Springer-Verlag
Published in: Neuroradiology / Issue 6/2012
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-011-0979-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

MRI and associated clinical characteristics of EV71-induced brainstem encephalitis in children with hand–foot–mouth disease

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2012

Perfusion-CT guided intravenous thrombolysis in patients with unknown-onset stroke: a randomized, double-blind, placebo-controlled, pilot feasibility trial

Correlation of aneurysm occlusion with actual metal coverage at neck after implantation of flow-diverting stent in rabbit models

MRI and thallium-201 SPECT in the prediction of survival in glioma

European Society of Neuroradiology (ESNR)

Cerebrotendinous xanthomatosis with progressive cerebellar vacuolation

Comparing quantitative tractography metrics of motor and sensory pathways in children with periventricular leukomalacia and different levels of gross motor function