High-resolution intracranial vessel wall imaging in cerebral viral infections evaluations

Abstract

Purpose Vascular complications can be seen in various viral CNS infections. Variable neuro-imaging findings have been described in the literature elucidating the parenchymal changes with vascular involvement. Vessel wall imaging (VWI) can help to detect these vascular involvements. We aimed to describe the role and usefulness of VWI in the evaluation of various viral CNS infections. Methods In this prospective study, we included 15 cases of various diagnosed viral CNS infections (varicella, HIV encephalopathy, HSV encephalitis, Japanese encephalitis, dengue, COVID-19). VWI and time-of-flight MR angiography (TOF MRA) were included in imaging protocol. All cases were evaluated for the presence of cerebral parenchymal changes, vascular enhancement, and vascular stenosis. Results We found infarctions in all 5 cases of varicella, 1 case of HIV encephalopathy, and 1 case of COVID-19 encephalopathy. All these cases also showed vascular enhancement and stenosis on VWI. The rest of the cases, including 1 case of HIV encephalopathy, 3 cases of herpes encephalitis, 2 cases of dengue, and 2 cases of Japanese encephalitis did not have any vascular complication, and also did not show vascular enhancement or stenosis. Conclusion VWI can be useful in the detection of vascular involvement in various viral infections of CNS which show a relatively higher cerebrovascular complication rate like varicella, HIV encephalopathy, and COVID-19. However, VWI may not be useful in the routine evaluation of other viral infections like herpes, dengue, and Japanese encephalitis, which have a very low rate of cerebrovascular complication rate.

Neuroinfectious Emergencies

“…38 Viral infections, primarily varicella-zoster virus and HIV, can also cause vasculopathy and associated infarcts and may be detected with vessel wall imaging, although these tend to be more insidious in onset. 39 Borrelia burgdorferi (Lyme disease) vasculitis is usually insidious but is associated with both ischemic and hemorrhagic stroke and may affect up to 1% of those with systemic infection in endemic parts of the world. 40,41 Newer research on vessel wall imaging by MRI suggests vessel wall enhancement is more prominent in fungal than bacterial infections.…”

“…Cryptococcus infection is also associated with ischemic strokes; 26% of these patients have basal ganglia lacunar infarcts 38 . Viral infections, primarily varicella-zoster virus and HIV, can also cause vasculopathy and associated infarcts and may be detected with vessel wall imaging, although these tend to be more insidious in onset 39 . Borrelia burgdorferi (Lyme disease) vasculitis is usually insidious but is associated with both ischemic and hemorrhagic stroke and may affect up to 1% of those with systemic infection in endemic parts of the world 40,41 .…”