[PS16-2D-2] MR imaging of central nervous viral infectious and parainfectious diseases in pediatric age
Clinical manifestations of infectious or parainfectious central nervous viral infectious and parainfectious diseases are various including meningitis, encephalitis, myelitis, acute disseminated encephalomyelitis (ADEM) and acute encephalopathy.
Fortunately, unlike bacterial infection, viral infection causes relatively specific changes on MRI. Each virus affects specific sites in the central nervous system, mainly gray matter; Herpes simplex virus 1,2 (HSV 1,2) and human herpes virus 6 (HHV6) affect limbic system when HHV6 also be causative of acute encephalopathy (acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) or mild encephalitis/encephalopathy with a reversible splenial lesion (MERS)), varicella-zoster virus (VZV) may cause infarction with vasculopathy in middle cerebral artery, Epstein-Barr virus (EBV) and Japanese encephalitis virus affect basal ganglia and thalamus, rota virus affect cerebellum and also causes MERS, influenza causes acute necrotizing encephalopathy of childhood (ANE), enterovirus 71 and D68 affect brain stem and gray matter spinal cord lesions and nerve root enhancement, and CMV and zika virus may cause brain developmental anomalies with congenital infection. ADEM, which may occur with or without preceding any viral infection, affect multiple gray and sub cortical white matter regions and spinal cord.
MRI especially diffusion weighted images (DWI) can visualize the affected sites as hyper intense lesions in acute stage of viral infectious and parainfectious diseases except for ADEM. In ADEM, FLAIR images are more sensitive than DWI. MRA is also useful in VZV infection detecting vasculopathy. Contrast enhanced study is not essential but useful when parainfectious disease by enterovirus is suspected.
In this talk, I would like to show what neuroradiologists see on MR I of central nervous viral infectious and parainfectious diseases in pediatric age.
Fortunately, unlike bacterial infection, viral infection causes relatively specific changes on MRI. Each virus affects specific sites in the central nervous system, mainly gray matter; Herpes simplex virus 1,2 (HSV 1,2) and human herpes virus 6 (HHV6) affect limbic system when HHV6 also be causative of acute encephalopathy (acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) or mild encephalitis/encephalopathy with a reversible splenial lesion (MERS)), varicella-zoster virus (VZV) may cause infarction with vasculopathy in middle cerebral artery, Epstein-Barr virus (EBV) and Japanese encephalitis virus affect basal ganglia and thalamus, rota virus affect cerebellum and also causes MERS, influenza causes acute necrotizing encephalopathy of childhood (ANE), enterovirus 71 and D68 affect brain stem and gray matter spinal cord lesions and nerve root enhancement, and CMV and zika virus may cause brain developmental anomalies with congenital infection. ADEM, which may occur with or without preceding any viral infection, affect multiple gray and sub cortical white matter regions and spinal cord.
MRI especially diffusion weighted images (DWI) can visualize the affected sites as hyper intense lesions in acute stage of viral infectious and parainfectious diseases except for ADEM. In ADEM, FLAIR images are more sensitive than DWI. MRA is also useful in VZV infection detecting vasculopathy. Contrast enhanced study is not essential but useful when parainfectious disease by enterovirus is suspected.
In this talk, I would like to show what neuroradiologists see on MR I of central nervous viral infectious and parainfectious diseases in pediatric age.