Is the brain spared in Crimean-Congo haemorrhagic fever? An MR-SWI study to reveal CNS involvement
- 162 Downloads
The aim of this prospective study is to investigate the central nervous system involvement in Crimean-Congo haemorrhagic fever (CCHF) with magnetic resonance imaging (MRI) in conjunction with clinical and laboratory findings.
Between July 2015 and August 2016, 36 patients with CCHF were undergone brain MRI including SWI. Two MRIs, one at the time of admission and the second in the convalescent period, were performed for each patient in order to see if there is any sign of central nervous system (CNS) involvement, especially in terms of intracranial haemorrhage or viral encephalitis. Clinical severity scoring was also done and laboratory findings were noted in order to correlate with clinical and imaging findings.
None of the 36 patients showed any MRI findings of an acute intracranial event during the course of the disease. There was a significant difference between mild cases and moderate cases in terms of some laboratory parameters (p < 0.05).
Although CCHF is a highly lethal disease which involves multiple organs and systems, CNS involvement seems to be extremely rare in mild and moderate cases.
• MRI is the imaging method of choice to diagnose microbleeds and encephalitis
• Although CCHF causes multisystem bleeding, intracranial haemorrhage seems to be very rare
• CNS complications are uncommon, even in the setting of suggestive symptoms
• Death usually results from extracranial bleeding and multiorgan failure
• Severity scoring is associated with some laboratory abnormalities in CCHF
KeywordsCentral nervous system Haemorrhage Magnetic resonance imaging Nairovirus Viral encephalitis
The authors thank the Scientific Research Projects Committee of Cumhuriyet University for their support.
This study has received funding by Scientific Research Projects program of Cumhuriyet University (CUBAP), Sivas, Turkey.
Compliance with ethical standards
The scientific guarantor of this publication is Prof. Dr. İbrahim Öztoprak, M.D., the head of the Department of Neuroradiology, Cumhuriyet University School of Medicine.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all patients in this study.
Institutional Ethics Committee approval was obtained (Decided on 12th May 2015; Decision No: 2015-05/09).
• diagnostic or prognostic study
• performed at one institution
- 6.Tülek N (2014) Kırım-Kongo Kanamalı Ateşi: Tanı ve Tedavi. Turkiye Klinikleri J Inf Dis-Special Topics 7(2):19–28Google Scholar
- 12.Osborn AG (2013) Osborn’s brain: imaging, pathology, and anatomy, 1st edn. Amirsys, Friesens, AltonaGoogle Scholar
- 13.Spengler JR, Keating MK, McElroy AK et al (2017) Crimean-Congo hemorrhagic fever in humanized mice reveals glial cells as primary targets of neurological infection. J Infect Dis. https://doi.org/10.1093/infdis/jix215
- 14.Butenko A (1971) Data from studying etiology, laboratory diagnosis and immunology of Crimean hemorrhagic fever: questions of ecology of the viral agent. Inst Polio Virusn Entsefalitov Akad Med Nauk SSSR Moskva [article in Russian]. (English version, US Naval Medical Research Unit No. 3–T1152)Google Scholar
- 22.Rausher A, Sedlacik J, Barth M, Mentzel HJ, Reichenbach JR (2005) Magnetic susceptibility-weighted MR phase imaging of the human brain. AJNR Am J Neuroradiol 26:736–742Google Scholar