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Non-congenital viral infections of the central nervous system: from the immunocompetent to the immunocompromised child


Non-congenital viral infections of the central nervous system in children can represent a severe clinical condition that needs a prompt diagnosis and management. However, the aetiological diagnosis can be challenging because symptoms are often nonspecific and cerebrospinal fluid analysis is not always diagnostic. In this context, neuroimaging represents a helpful tool, even though radiologic patterns sometimes overlap. The purpose of this pictorial essay is to suggest a schematic representation of different radiologic patterns of non-congenital viral encephalomyelitis based on the predominant viral tropism and vulnerability of specific regions: cortical grey matter, deep grey matter, white matter, brainstem, cerebellum and spine.

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  1. Bale JF Jr (2015) Virus and immune-mediated encephalitides: epidemiology, diagnosis, treatment, and prevention. Pediatr Neurol 53:3–12

    Article  PubMed  Google Scholar 

  2. Baskin HJ, Hedlund G (2007) Neuroimaging of herpes virus infections in children. Pediatr Radiol 37:949–963

    Article  PubMed  Google Scholar 

  3. Lo CP, Chen CY (2008) Neuroimaging of viral infections in infants and young children. Neuroimaging Clin N Am 18:119–132

    Article  PubMed  Google Scholar 

  4. Kidokoro H, de Vries LS, Ogawa C et al (2017) Predominant area of brain lesions in neonates with herpes simplex encephalitis. J Perinatol 37:1210–1214

    Article  CAS  PubMed  Google Scholar 

  5. Zuccoli G, Yannes MP, Nardone R et al (2015) Bilateral symmetrical basal ganglia and thalamic lesions in children: an update. Neuroradiology 57:973–989

    Article  PubMed  Google Scholar 

  6. Beattie GC, Glaser CA, Sheriff H et al (2012) Encephalitis with thalamic and basal ganglia abnormalities: etiologies, neuroimaging, and potential role of respiratory viruses. Clin Infect Dis 56:825–832

    Article  PubMed  Google Scholar 

  7. Ali M, Safriel Y, Sohi J et al (2005) West Nile virus infection: MR imaging findings in the nervous system. AJNR Am J Neuroradiol 26:289–297

    PubMed  PubMed Central  Google Scholar 

  8. Sarma A, Hanzlik E, Krishnasarma R et al (2019) Human parechovirus meningoencephalitis: neuroimaging in the era of polymerase chain reaction–based testing. AJNR Am J Neuroradiol 40:1418–1421

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Verboon-Maciolek MA, Groenendaal F, Hahn CD et al (2008) Human parechovirus causes encephalitis with white matter injury in neonates. Ann Neurol 64:266–273

    Article  PubMed  Google Scholar 

  10. Volpe JJ (2008) Neonatal encephalitis and white matter injury: more than just inflammation? Ann Neurol 64:232–236

    Article  PubMed  PubMed Central  Google Scholar 

  11. Bissel SJ, Auer RN, Chiang CH et al (2015) Human parechovirus 3 meningitis and fatal leukoencephalopathy. J Neuropathol Exp Neurol 74:767–777

    Article  PubMed  Google Scholar 

  12. Amarnath C, Helen Mary T, Periakarupan A et al (2016) Neonatal parechovirus leucoencephalitis — radiological pattern mimicking hypoxic-ischemic encephalopathy. Eur J Radiol 85:428–434

    Article  CAS  PubMed  Google Scholar 

  13. Yeom JS, Park CH (2016) White matter injury following rotavirus infection in neonates: new aspects to a forgotten entity, ‘fifth day fits’? Korean J Pediatr 59:285–291

    Article  PubMed  PubMed Central  Google Scholar 

  14. Chen F, Li J, Liu T et al (2013) Original article MRI characteristics of brainstem encephalitis in hand-foot-mouth disease induced by enterovirus Type 71 — will different MRI manifestations be helpful for prognosis? Eur J Paediatr Neurol 17:486–491

    Article  PubMed  Google Scholar 

  15. Takanashi J, Miyamoto T, Ando N et al (2010) Clinical and radiological features of rotavirus cerebellitis. AJNR Am J Neuroradiol 31:1591–1595

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Helfferich J, Knoester M, Van Leer-Buter CC et al (2019) Acute flaccid myelitis and enterovirus D68: lessons from the past and present. Eur J Pediatr 178:1305–1315

    Article  PubMed  PubMed Central  Google Scholar 

  17. Yokota H, Yamada K (2015) Viral infection of the spinal cord and roots. Neuroimaging Clin N Am 25:247–258

    Article  PubMed  Google Scholar 

  18. Zunt JR (2002) Central nervous system infection during immunosuppression. Neurol Clin 20:1–22

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ongrádi J, Ablashi DV, Yoshikawa T et al (2017) Roseolovirus-associated encephalitis in immunocompetent and immunocompromised individuals. J Neuro-Oncol 23:1–19

    Google Scholar 

  20. Schwenk H, Ramirez-Avila L, Sheu S-H et al (2014) Progressive multifocal leukoencephalopathy in pediatric patients. Pediatr Infect Dis J 33:99–105

    Article  Google Scholar 

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Correspondence to Maria Camilla Rossi-Espagnet.

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Moltoni, G., D’Arco, F., Pasquini, L. et al. Non-congenital viral infections of the central nervous system: from the immunocompetent to the immunocompromised child. Pediatr Radiol 50, 1757–1767 (2020).

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