Reversible Diffusion-Weighted MR Findings of &lt;i&gt;Salmonella enteritidis&lt;/i&gt;-Associated Encephalopathy

Kobuchi, N.; Tsukahara, Hirokazu; Kawamura, Yasutaka; Ishimori, Yoshiyuki; Ohshima, Yusei; Hiraoka, M.; Hiraizumi, Yutaka; Ueno, Masaki; Mayumi, Mitsufumi

doi:10.1159/000069074

Cited by 40 publications

(33 citation statements)

References 4 publications

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“…[6][7][8][9] Ali et al 10 reported restricted diffusion in 7 of 14 patients infected with West Nile virus. Restricted diffusion precedes signal abnormalities seen on fluid-attenuated inversion recovery (FLAIR) images and is also known to resolve earlier than the FLAIR signal abnormalities during the recovery period.…”

Section: Discussionmentioning

confidence: 99%

Chikungunya Encephalomyeloradiculitis: Report of 2 Cases with Neuroimaging and 1 Case with Autopsy Findings

Ganesan¹,

Diwan²,

Shankar³

et al. 2008

AJNR Am J Neuroradiol

108

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SUMMARY:Chikungunya, an alphavirus presenting with fever, rash, and polyarthritis, is derived from the Makonde word that means "that which bends up," in reference to the crippling manifestations of the disease. Most often it is a self-limiting febrile illness. Neurologic complications of Chikungunya infection have been reported. We are reporting the clinical and neuroimaging data in 2 patients with Chikungunya encephalomyeloradiculitis and brain autopsy findings in 1 patient. Chikungunya virus was first isolated in Calcutta, India, in 1963, 1 with several reported outbreaks in India since then. The first isolation of the disease worldwide was in 1952, following an outbreak on the Makonde Plateau. The symptoms include fever, headache, rash, and severe arthralgia. Many of these symptoms are indistinguishable from dengue fever, and simultaneous isolation of both dengue and Chikungunya from sera of patients has been reported.2 Chikungunya virus, an Old World alphavirus, is related antigenically to O'nyongnyong virus and is not known to be neurotropic. However, meningoencephalitis has been reported in outbreaks in India and the Reunion Islands. 3,4 We present the clinical, neuroimaging, and brain autopsy findings of Chikungunya encephalomyeloradiculitis, a relatively unknown and rare complication of the infection. Case Reports Case 1A 65-year-old man had low-grade fever and joint pain, which were treated with analgesics. A few days later he became drowsy. Findings of a complete blood analysis were normal. However, the patient's condition deteriorated clinically. On examination, he was semiconscious with neck rigidity, no limb movements, and an extensor plantar response. CSF analysis revealed elevated proteins, low sugars, and a few cells with lymphocyte predominance. CSF and serum were positive for immunoglobulin M (IgM) antibodies to Chikungunya virus. Intravenous methylprednisolone was administered for 5 days with 5 cycles of plasmapheresis. The patient was shifted to our hospital 45 days after the onset of symptoms. Electromyography (EMG) and nerve-conduction studies revealed acute generalized motor axonal neuropathy with no sensory component. Brain MR imaging revealed bilateral frontoparietal white matter lesions with restricted diffusion (Fig 1A), which enhanced on postcontrast T1-weighted (T1WI) fatsaturated images (Fig 1B). Spinal MR imaging revealed enhancement of the ventral cauda equina nerve roots (Fig 1C). He was administered IV dexamethasone and given supportive treatment; however, he did not improve clinically and was lost to further follow-up. Case 2A 73-year-old man had fever and joint pain, which were treated with analgesics. A few days later, he became drowsy and unresponsive with reduced limb movements. He was admitted 1 week after initial onset of symptoms. Examination revealed absent deep tendon reflexes with an extensor plantar response. CSF studies revealed increased cells (predominantly lymphocytes), elevated proteins, and low sugar. CSF and serum were positive for IgM antibodies to the Chikun...

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Section: Discussionmentioning

confidence: 99%

Chikungunya Encephalomyeloradiculitis: Report of 2 Cases with Neuroimaging and 1 Case with Autopsy Findings

Ganesan¹,

Diwan²,

Shankar³

et al. 2008

AJNR Am J Neuroradiol

108

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“…The authors postulated that the lesion aetiopathogenesis and evolution could be related to medications used during treatment, as they were transient in nature and disappeared upon suspension of Phenytoin and Vigabatrin [3]. In subsequent studies, several authors reported the detection on MRI of transient focal cerebral abnormalities with similar features in patients with no evidence of seizures who were undergoing examination due to suspected viral encephalitis [4], rotavirus encephalopathy [5], acute cerebellitis [6], low-grade glioma [7], haemolytic-uraemic syndrome [8], salmonella-enteritidis-related encephalitis [9] and high-altitude cerebral oedema [10].…”

Section: Introductionmentioning

confidence: 99%

“…[3]. In seguito, diversi lavori hanno riportato il riscontro di analoghe lesioni con le medesime caratteristiche in corso di condizioni differenti dall'epilessia quali encefaliti virali [4], encefalopatie da rotavirus [5], cerebelliti acute [6], glomi di basso grado [7], sindrome emolitico-uremica [8], encefaliti associate alla Salmonella enteritidis [9] ed edema cerebrale da altitudine [10].…”

Section: Introduzioneunclassified

Transient focal lesion in the splenium of the corpus callosum: MR imaging with an attempt to clinical-physiopathological explanation and review of the literature

et al. 2007

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“…The reversible central splenial lesion of the corpus callosum on MRI examination has been observed in patients with various infectious encephalitis/encephalopathy, such as rotavirus (4), measles virus (5), and Salmonella enteritis (6). Furthermore, a similar transient splenial lesion of the corpus collosum on MRI has been also demonstrated in both child and adult patients with seasonal influenza complicated by encephalitis/encephalopathy (7)(8)(9).…”

Section: Discussionmentioning

confidence: 90%

Transient Splenial Lesion of the Corpus Callosum in H1N1 Influenza Virus-Associated Encephalitis/Encephalopathy

et al. 2011

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A 26-year-old man was admitted to our hospital because of high fever, drowsiness, memory disturbance, and disorientation due to H1N1 influenza virus-associated encephalitis/encephalopathy. All of his symptoms rapidly improved following methylprednisolone pulse therapy. The diffusion-weighted image of brain magnetic resonance imaging (MRI) revealed a large transient hyperintense signal lesion on the central splenium of the corpus callosum. This MRI finding in conjunction with a complete clinical recovery has been previously observed in cases of clinically mild seasonal influenza-associated encephalitis/encephalopathy, and can be also a useful clue for the diagnosis of new type of influenza, H1N1 influenza virus infection complicated by encephalitis/encephalopathy.

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Reversible Diffusion-Weighted MR Findings of <i>Salmonella enteritidis</i>-Associated Encephalopathy

Cited by 40 publications

References 4 publications

Chikungunya Encephalomyeloradiculitis: Report of 2 Cases with Neuroimaging and 1 Case with Autopsy Findings

Chikungunya Encephalomyeloradiculitis: Report of 2 Cases with Neuroimaging and 1 Case with Autopsy Findings

Transient focal lesion in the splenium of the corpus callosum: MR imaging with an attempt to clinical-physiopathological explanation and review of the literature

Transient Splenial Lesion of the Corpus Callosum in H1N1 Influenza Virus-Associated Encephalitis/Encephalopathy

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