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Neuroradiology

, Volume 54, Issue 3, pp 239–245 | Cite as

Enterovirus 71-related encephalomyelitis: usual and unusual magnetic resonance imaging findings

  • Seonah Jang
  • Sang-il Suh
  • Su Min Ha
  • Jung Hye Byeon
  • Baik-Lin Eun
  • Young Hen Lee
  • Hyung Suk Seo
  • So-Hee Eun
  • Hae-Young Seol
Paediatric Neuroradiology

Abstract

Introduction

Most enterovirus (EV) 71 infections manifest as mild cases of hand–foot–mouth disease (HFMD)/herpangina with seasonal variations, having peak incidence during the summer. Meanwhile, EV 71 may involve the central nervous system (CNS), causing severe neurologic disease. In many cases, enteroviral encephalomyelitis involves the central midbrain, posterior portion of the medulla oblongata and pons, bilateral dentate nuclei of the cerebellum, and the ventral roots of the cervical spinal cord, and the lesions show hyperintensity on T2-weighted and fluid-attenuation inversion recovery (FLAIR) images. Our goal was to review usual and unusual magnetic resonance (MR) findings in CNS involvement of enteroviral infection.

Methods

Among consecutive patients who had HFMD and clinically suspected encephalitis or myelitis and who underwent brain or spinal MR imaging, five patients revealed abnormal MR findings. Diffusion-weighted and conventional MR and follow-up MR images were obtained. From cerebrospinal fluid, stool, or nasopharyngeal swabs, EV 71 was confirmed in all patients.

Results

MR imaging studies of two patients showed hyperintensity in the posterior portion of the brainstem on T2-weighted and FLAIR images, which is the well-known MR finding of EV 71 encephalitis. The remaining three cases revealed unusual manifestations: leptomeningeal enhancement, abnormal enhancement along the ventral roots at the conus medullaris level without brain involvement, and hyperintensity in the left hippocampus on T2/FLAIR images.

Conclusion

EV 71 encephalomyelitis shows relatively characteristic MR findings; therefore, imaging can be helpful in radiologic diagnosis. However, physicians should also be aware of unusual radiologic manifestations of EV 71.

Keywords

Enterovirus 71 Encephalitis Magnetic resonance 

Notes

Conflict of interest

We declare that we have no conflict of interest.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Seonah Jang
    • 1
  • Sang-il Suh
    • 1
  • Su Min Ha
    • 1
  • Jung Hye Byeon
    • 2
  • Baik-Lin Eun
    • 2
  • Young Hen Lee
    • 3
  • Hyung Suk Seo
    • 3
  • So-Hee Eun
    • 4
  • Hae-Young Seol
    • 1
  1. 1.Department of RadiologyKorea University Guro Hospital, Korea University College of MedicineSeoulSouth Korea
  2. 2.Department of PediatricsKorea University Guro Hospital, Korea University College of MedicineSeoulSouth Korea
  3. 3.Department of RadiologyKorea University Ansan Hospital, Korea University College of MedicineAnsanSouth Korea
  4. 4.Department of PediatricsKorea University Ansan Hospital, Korea University College of MedicineAnsanSouth Korea

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