CT, MRI and MRS of Epstein-Barr virus infection: case report

Abstract

We report MRI and proton MR spectroscopy (MRS) findings in a 12-month-old girl with Epstein-Barr virus encephalitis. CT and MRI showed focal lesions in the basal ganglia. MRS of the lesions showed decreased N-acetyl aspartate and elevation of some amino acids, indicating an infectious rather than ischemic etiology. This case illustrates the use of MRS to narrow differential diagnosis.

Serial diffusion-weighted MR imaging findings in a patient with Epstein-Barr virus encephalitis

“…Since neuroimaging studies are normal in the majority of patients with EBV encephalitis, available reports of MRI abnormalities are limited but describe lesions that involve the basal ganglia [1][2][3], brainstem [4,5], thalamus [1,6], splenium of the corpus callosum [7], and cerebral cortex [1]. The distribution of signal abnormalities in our patient was primarily confined to the bilateral basal ganglia, consistent with the characteristic MRI findings of EBV encephalitis [1][2][3].…”

“…The distribution of signal abnormalities in our patient was primarily confined to the bilateral basal ganglia, consistent with the characteristic MRI findings of EBV encephalitis [1][2][3]. Differential diagnoses of the disorders that preferentially affect bilateral basal ganglia are extensive and include Japanese encephalitis, tick-borne encephalitis, anoxic encephalopathy, hypoglycemic encephalopathy, mitochondrial encephalopathy, carbon monoxide poisoning, Lyme encephalitis, Creutzfeldt-Jakob disease, Wilson disease, Huntington disease, and acute demyelinating encephalomyelitis (ADEM).…”

Thalamic involvement of Epstein-Barr virus encephalitis demonstrated by MRI

“…EBV is reported to cause bilateral basal ganglia lesions [2] and brainstem lesions [1], and recently, a unilateral thalamic lesion with multiple cerebral and brainstem lesions was reported in a renal transplant recipient with EBV encephalitis [3]. However, to our knowledge, there is no report of EBV encephalitis with lesions involving the thalamus bilaterally, like those of Japanese encephalitis.…”

“…Although imaging studies are normal in the majority of patients with EBV encephalitis, basal ganglia or brainstem lesions are detected in some cases [1,2]. Thalamic lesions, however, are rarely reported in cases of EBV encephalitis.…”

Basal ganglia and brainstem encephalitis, optic neuritis, and radiculomyelitis in Epstein–Barr virus infection

“…4e6 In some patients, MRI shows diffuse brain swelling or focal areas of increased SI on T2-weighted images. There is only one report each of EBV encephalitis with bilateral basal ganglia lesions, 13 bilateral thalamic and basal ganglia lesions, 14 brainstem lesions, 15 and unilateral thalamic lesion with multiple cerebral and brainstem lesions. 16 Thus, our patient is the first report of EBV encephalitis with bilateral basal ganglia and brainstem lesions.…”