Journal of Neurology

, Volume 259, Issue 8, pp 1742–1745 | Cite as

Hyperintense lesion in the corpus callosum associated with Puumala hantavirus infection

  • Thorsten Steiner
  • Jakob Ettinger
  • Zhongying Peng
  • Jörg Hofmann
  • Marius Hartmann
  • Ulrich Burkhardt
  • Paul SchnitzlerEmail author
Letter to the Editors

Dear Sir,

A 38-year-old female presented with a 4-day history of acute onset of headache, fever of 40°C, and generalized fatigue at a peripheral hospital. The patient presented no neurological deficits, especially no signs of meningism, and the remaining examination was normal. The CRP was increased (192 mg/l, normal <5 mg/l). Creatinine (1.03 mg/dl) and blood urea nitrogen (38.0 mg/dl) were normal. The cranial CT scanning excluded subarachnoid hemorrhage. A cranial MRI excluded cerebral venous sinus thrombosis, but showed a hyperintense lesion in the splenium of the corpus callosum (Fig.  1a–c). The patient was transferred to the university hospital. A lumbar puncture could not be performed at that time, due to thrombocytopenia and abnormal coagulation (platelets 51 × 10 3/μl and the partial thromboplastin (PTT) time was prolonged to 44.1 s). The general condition of health was reduced, accompanied by tachycardia and dyspnea, but vigilance was not affected and neurological examination...


Corpus Callosum Rabies Bank Vole Cerebral Venous Sinus Thrombosis Nipah Virus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Expert technical assistance by Mrs. C. Stephan (Charité Berlin) is gratefully acknowledged.

Conflicts of interest



  1. 1.
    Klempa B, Fichet-Calvet E, Lecompte E, Auste B, Aniskin V, Meisel H, Denys C, Koivogui L, ter Meulen J, Krüger DH (2006) Hantavirus in African wood mouse, Guinea. Emerg Infect Dis 12:838–840PubMedCrossRefGoogle Scholar
  2. 2.
    Schilling S, Emmerich P, Klempa B, Auste B, Schnaith E, Schmitz H, Krüger DH, Günther S, Meisel H (2007) Hantavirus disease outbreak in Germany: limitations of routine serological diagnostics and clustering of virus sequences of human and rodent origin. J Clin Microbiol 45:3008–3014PubMedCrossRefGoogle Scholar
  3. 3.
    Hofmann J, Meisel H, Klempa B, Vesenbeckh SM, Beck R, Michel D, Schmidt-Chanasit J, Ulrich RG, Grund S, Enders G, Kruger DH (2008) Hantavirus outbreak, Germany, 2007. Emerg Infect Dis 14:850–852PubMedCrossRefGoogle Scholar
  4. 4.
    Schwarz AC, Ranft U, Piechotowski I, Childs JE, Brockmann SO (2009) Risk factors for human infection with Puumala virus, southwestern Germany. Emerg Infect Dis 15:1032–1039PubMedCrossRefGoogle Scholar
  5. 5.
    Faber MS, Ulrich RG, Frank C, Brockmann SO, Pfaff GM, Jacob J, Kruger DH, Stark K (2010) Steep rise in notified hantavirus infections in Germany, April 2010. Euro Surveill 15Google Scholar
  6. 6.
    Zelena H, Zvolankova V, Zuchnicka J, Liszkova K, Papa A (2011) Hantavirus infection during a stay in a mountain hut in northern Slovakia. J Med Virol 83:496–500PubMedCrossRefGoogle Scholar
  7. 7.
    Jonsson CB, Figueiredo LT, Vapalahti O (2010) A global perspective on hantavirus ecology, epidemiology, and disease. Clin Microbiol Rev 23:412–441PubMedCrossRefGoogle Scholar
  8. 8.
    Abu Sin M, Stark K, van Treeck U, Dieckmann H, Uphoff H, Hautmann W, Bornhofen B, Jensen E, Pfaff G, Koch J (2007) Risk factors for hantavirus infection in Germany, 2005. Emerg Infect Dis 13:1364–1366PubMedGoogle Scholar
  9. 9.
    Tersago K, Verhagen R, Servais A, Heyman P, Ducoffre G, Leirs H (2009) Hantavirus disease (nephropathia epidemica) in Belgium: effects of tree seed production and climate. Epidemiol Infect 137:250–256PubMedCrossRefGoogle Scholar
  10. 10.
    Eckerle I, Jakob E, Hofmann J, Schmidt-Bacher A, Ettinger J, Schnitzler P (2012) Atypical severe Puumala hantavirus infection and virus sequence analysis of the patient and regional reservoir host. Zoon Pub Health (in press)Google Scholar
  11. 11.
    Hautala T, Mähonen SM, Sironen T, Hautala N, Pääkö E, Karttunen A, Salmela PI, Ilonen J, Vainio O, Glumoff V, Rytky S, Plyusnin A, Vaheri A, Vapalahti O, Kauma H (2010) Central nervous system-related symptoms and findings are common in acute Puumala hantavirus infection. Ann Med 42:344–351PubMedCrossRefGoogle Scholar
  12. 12.
    Hackett PH, Yarnell PR, Hill R, Reynard K, Heit J, McCormick J (1998) High-altitude cerebral edema evaluated with magnetic resonance imaging: clinical correlation and pathophysiology. JAMA 280:1920–1925PubMedCrossRefGoogle Scholar
  13. 13.
    Hackett PH, Roach RC (2001) High-altitude illness. N Engl J Med 345:107–114PubMedCrossRefGoogle Scholar
  14. 14.
    Rumbold Z (2008) Imaging of topographic viral CNS infections. Neuroimag Clin N Am 18:85–92CrossRefGoogle Scholar
  15. 15.
    Gallucci M, Limbucci N, Paonessa A, Carnanci F (2007) Reversible focal splenial lesions. Neuroradiology 49:541–544PubMedCrossRefGoogle Scholar
  16. 16.
    Battal B, Kocaoglu M, Akgun V, Bulakbasi N, Tayfun C (2010) Corpus callosum: normal imaging appearance, variants and pathologic conditions. J Med Imaging Radiat Oncol 54:541–549PubMedCrossRefGoogle Scholar
  17. 17.
    Braun N, Haap M, Overkamp D, Kimmel M, Alscher MD, Lehnert H, Haas CS (2010) Characterization and outcome following Puumala virus infection: a retrospective analysis of 75 cases. Nephrol Dial Transplant 25:2997–3003PubMedCrossRefGoogle Scholar
  18. 18.
    Kramski M, Meisel H, Klempa B, Kruger DH, Pauli G, Nitsche A (2007) Detection and typing of human pathogenic hantaviruses by real-time reverse transcription-PCR and pyrosequencing. Clin Chem 53:1899–1905PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Thorsten Steiner
    • 1
  • Jakob Ettinger
    • 3
  • Zhongying Peng
    • 2
  • Jörg Hofmann
    • 3
  • Marius Hartmann
    • 4
  • Ulrich Burkhardt
    • 5
  • Paul Schnitzler
    • 5
    Email author
  1. 1.Department of NeurologyKlinikum Frankfurt HöchstFrankfurtGermany
  2. 2.Department of NeurologyUniversity of HeidelbergHeidelbergGermany
  3. 3.Institute of Medical Virology, Helmut-Ruska-HausCharité University MedicineBerlinGermany
  4. 4.Department of NeuroradiologyHelios Klinikum Berlin-BuchBerlinGermany
  5. 5.Department of Infectious Diseases, VirologyUniversity of HeidelbergHeidelbergGermany

Personalised recommendations