Human parechovirus causes encephalitis with white matter injury in neonates

Verboon-Maciolek, Malgorzata A.; Groenendaal, Floris; Hahn, Cecil D.; Hellmann, Jonathan; Loon, Anton M. van; Boivin, Guy; Vries, Linda S. de

doi:10.1002/ana.21445

Cited by 271 publications

(264 citation statements)

References 27 publications

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“…MRI is a pertinent investigation in the diagnosis of encephalitis in neonates presenting with seizures, as CSF examination can be normal in viral encephalitis. 22 Hence our study emphasizes the importance of MRI in the evaluation of neonatal seizures.…”

Section: Discussionmentioning

confidence: 72%

“…This pattern had to be distinguished from MRI abnormality due to other viral etiology like HSV, as HSV encephalitis involve both white matter and grey matter. 22 Confirmatory testing could not be done, as PCR for parechovirus was not available. MRI is a pertinent investigation in the diagnosis of encephalitis in neonates presenting with seizures, as CSF examination can be normal in viral encephalitis.…”

Section: Discussionmentioning

confidence: 99%

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Spectrum of magnetic resonance imaging abnormalities in neonatal seizures in a tertiary care hospital in India

Shaik¹,

Ratnavelu²,

Balakrishnan³

et al. 2016

Int J Contemp Pediatr

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INTRODUCTIONSeizure is the most common neurological presentation during the first month of life and can lead to adverse long term outcome.1-4 A specific etiology for the seizure can be better detected in infants compared to children. 5However in 12-15% of newborns the etiology remains unknown.6-8 Magnetic resonance imaging (MRI) is a valuable tool for identifying structural abnormalities which may be the underlying etiology for neonatal seizures and it is also more sensitive to detect subtle changes compared to neurosonogram or computed tomography. 9 In developed countries, MRI of brain has become a standard investigation over a period of time but not yet in developing countries due to the lack of availability of equipment and expertise.7,10 MRI is not only helpful to detect the underlying brain etiology but also to prognosticate. 11Data on MRI findings in neonatal seizures are sparse in developing countries. Hence the objective of this study is ABSTRACT Background: Seizure is the most common neurological presentation during the first month of life and can lead to adverse long term outcome. The aim of the study was to describe the spectrum of brain lesions identified by magnetic resonance imaging (MRI) in term babies presenting with neonatal seizures. Methods: This retrospective descriptive study was done in a tertiary care hospital. The study subjects included term neonates presenting with neonatal seizures admitted in neonatal intensive care unit over a 5 year period, who underwent MRI brain. Data was collected from the medical records and radiology department. Results: Out of 189 neonates presenting with seizures, 155 underwent MRI brain. Brain lesions were identified in 122 (79%) babies. The most common etiological diagnosis was hypoxic ischemic encephalopathy (HIE) which was noted in 43 (28%) neonates. The other findings in the decreasing order were encephalitis in 35 (23%), metabolic disorder in 16 (10%), haemorrhage in 15 (9.7%) vascular in 12 (8%) and cortical dysplasia in 1 (<1%) neonates. Conclusions: MRI identified brain lesions in 79% of infants who presented with neonatal seizures. In accordance with the literature, our studies also revealed HIE as the commonest brain lesion. The diagnosis of neonatal stroke and encephalitis was made specifically with the aid of MRI. MRI showed changes consistent with diagnosis of encephalitis in a significant proportion of babies. We suggest that MRI should be considered as a standard investigation during the evaluation and management of neonatal seizures.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Spectrum of magnetic resonance imaging abnormalities in neonatal seizures in a tertiary care hospital in India

Shaik¹,

Ratnavelu²,

Balakrishnan³

et al. 2016

Int J Contemp Pediatr

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“…Studies using this protocol [21,22] have demonstrated a higher sensitivity in predicting outcomes than those applying brain US on a less frequent basis [23,24]. Serial US will not miss: (1) periventricular cysts of focal periventricular leukomalacia (PVL), which appear after the first postnatal week, progressively coalesce and then disappear at about term-equivalent age by forming the wall of the lateral ventricles [4,11]; (2) periventricular clastic lesions secondary to sepsis, necrotizing enterocolitis and viral and fungal infections developing any time in the neonatal period [11,[14][15][16]25]; (3) post-haemorrhagic ventricular dilatation that may develop any time after intraventricular hemorrhage [26], and (4) perforator stroke occurring any time after the first week and sometimes affecting the posterior limb of the internal capsule [12].…”

Section: When Do We Perform Us?mentioning

confidence: 99%

“…Perforator stroke occurs in the distribution of lenticulostriate arteries, and in preterm neonates it is often subclinical [12]. Viral or fungal infections can affect the brain of very-low-birth-weight infants and these can give rise to multicystic periventricular leukomalacia, multiple brain abscesses and haemorrhagic infarcts [13][14][15][16].…”

mentioning

confidence: 99%

The rationale for routine cerebral ultrasound in premature infants

Argyropoulou

Veyrac

2015

Pediatr Radiol

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“…Beside HSV infection, there are many species of enterovirus (represented mainly by coxsackie B virus and poliovirus), echovirus and parechovirus, which can cause severe meningitis and meningoencephalitis in the neonatal period, with secondary severe neurodevelopmental disabilities [36,37]. Perinatal enteroviral intracranial infection manifests itself most commonly as viral "aseptic" meningitis (by CSF criteria), caused by primary viral infection of the meninges and characterised by inflammatory infiltration of the pia-arachnoid [38].…”

Section: Viral Infectionmentioning

confidence: 99%

Neonatal brain infections

Schneider

2011

Pediatr Radiol

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Infections of the brain in the neonatal period differ considerably from infections in the older child, due to a variety of age-specific factors that are related not only to the child, but also to the mother, and to specific pathogenic organisms. It has been recognized that clinical and neurological signs are often non-specific, sometimes scarce, and seldom correlate with the extent of neuroimaging findings, thus warranting early imaging to ensure timely therapy and improved outcome.

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Human parechovirus causes encephalitis with white matter injury in neonates

Cited by 271 publications

References 27 publications

Spectrum of magnetic resonance imaging abnormalities in neonatal seizures in a tertiary care hospital in India

Spectrum of magnetic resonance imaging abnormalities in neonatal seizures in a tertiary care hospital in India

The rationale for routine cerebral ultrasound in premature infants

Neonatal brain infections

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