Respiratory syncytial virus-related encephalitis: Magnetic resonance imaging findings with diffusion-weighted study

Arim Park, Sang-Il Suh, Gyu Ri Son, Young Hen Lee, Hyung Suk Seo, Baik-Lin Eun, Nam-Joon Lee, Hae Young Seol

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Introduction: Respiratory syncytial virus (RSV) is a common pathogen causing acute respiratory infection in children. Herein, we describe the incidence and clinical and magnetic resonance imaging (MRI) findings of RSV-related encephalitis, a major neurological complication of RSV infection. Methods: We retrospectively reviewed the medical records and imaging findings of the patients over the past 7 years who are admitted to our medical center and are tested positive for RSV-RNA by reverse transcriptase PCR. In total, 3,856 patients were diagnosed with RSV bronchiolitis, and 28 of them underwent brain MRI for the evaluation of neurologic symptoms; 8 of these 28 patients had positive imaging findings. Five of these 8 patients were excluded because of non-RSV-related pathologies, such as subdural hemorrhage, brain volume loss due to status epilepticus, periventricular leukomalacia, preexisting ventriculomegaly, and hypoxic brain injury. Results: The incidence of RSV-related encephalitis was as follows: 3/3,856 (0.08 %) of the patients are positive for RSV RNA, 3/28 (10.7 %) of the patient underwent brain MRI for neurological symptom, and 3/8 (37.5 %) of patients revealed abnormal MR findings. The imaging findings were suggestive of patterns of rhombenmesencephalitis, encephalitis with acute disseminated encephalomyelitis, and limbic encephalitis. They demonstrated no diffusion abnormality on diffusion-weighted image and symptom improvement on the follow-up study. Conclusion: Encephalitis with RSV bronchiolitis occurs rarely. However, on brain MRI performed upon suspicion of neurologic involvement, RSV encephalitis is not infrequently observed among the abnormal MR findings and may mimic other viral and limbic encephalitis. Physicians should be aware of this entity to ensure proper diagnosis and neurologic care of RSV-positive patients.

Original languageEnglish
Pages (from-to)163-168
Number of pages6
JournalNeuroradiology
Volume56
Issue number2
DOIs
Publication statusPublished - 2014 Feb 1

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Respiratory Syncytial Viruses
Encephalitis
Magnetic Resonance Imaging
Limbic Encephalitis
Bronchiolitis
Brain
Nervous System
Acute Disseminated Encephalomyelitis
Viral Encephalitis
Periventricular Leukomalacia
Respiratory Syncytial Virus Infections
Subdural Hematoma
Status Epilepticus
RNA-Directed DNA Polymerase
Incidence
Diagnostic Imaging
Neurologic Manifestations
Reverse Transcriptase Polymerase Chain Reaction
Respiratory Tract Infections
Brain Injuries

Keywords

  • Encephalitis
  • Magnetic resonance
  • Respiratory syncytial virus

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Respiratory syncytial virus-related encephalitis : Magnetic resonance imaging findings with diffusion-weighted study. / Park, Arim; Suh, Sang-Il; Son, Gyu Ri; Lee, Young Hen; Seo, Hyung Suk; Eun, Baik-Lin; Lee, Nam-Joon; Seol, Hae Young.

In: Neuroradiology, Vol. 56, No. 2, 01.02.2014, p. 163-168.

Research output: Contribution to journalArticle

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abstract = "Introduction: Respiratory syncytial virus (RSV) is a common pathogen causing acute respiratory infection in children. Herein, we describe the incidence and clinical and magnetic resonance imaging (MRI) findings of RSV-related encephalitis, a major neurological complication of RSV infection. Methods: We retrospectively reviewed the medical records and imaging findings of the patients over the past 7 years who are admitted to our medical center and are tested positive for RSV-RNA by reverse transcriptase PCR. In total, 3,856 patients were diagnosed with RSV bronchiolitis, and 28 of them underwent brain MRI for the evaluation of neurologic symptoms; 8 of these 28 patients had positive imaging findings. Five of these 8 patients were excluded because of non-RSV-related pathologies, such as subdural hemorrhage, brain volume loss due to status epilepticus, periventricular leukomalacia, preexisting ventriculomegaly, and hypoxic brain injury. Results: The incidence of RSV-related encephalitis was as follows: 3/3,856 (0.08 {\%}) of the patients are positive for RSV RNA, 3/28 (10.7 {\%}) of the patient underwent brain MRI for neurological symptom, and 3/8 (37.5 {\%}) of patients revealed abnormal MR findings. The imaging findings were suggestive of patterns of rhombenmesencephalitis, encephalitis with acute disseminated encephalomyelitis, and limbic encephalitis. They demonstrated no diffusion abnormality on diffusion-weighted image and symptom improvement on the follow-up study. Conclusion: Encephalitis with RSV bronchiolitis occurs rarely. However, on brain MRI performed upon suspicion of neurologic involvement, RSV encephalitis is not infrequently observed among the abnormal MR findings and may mimic other viral and limbic encephalitis. Physicians should be aware of this entity to ensure proper diagnosis and neurologic care of RSV-positive patients.",
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