Enterovirus rhombencephalitis is the most common neurological complication of enterovirus infection 1.
Enterovirus rhombencephalitis causes acute and severe neurologic disorders such as ataxia, nystagmus, oculomotor palsies, or bulbar palsy. In some cases, neurologic affection can extend to the spinal cord 1.
EV71 brainstem encephalitis occasionally induces autonomic dysfunction, such as fluctuating blood pressure and pulmonary hemorrhage/edema leading to death.
Diagnosis usually made by neuroimaging findings in conjunction with virus isolation from at least one site (e.g. throat swab, stool, CSF).
Brainstem is the most common site of involvement. High signal intensities may be seen on T2-weighted and fluid-attenuated inversion recovery images in the dorsal aspect of the pons, medulla, midbrain, and dentate nuclei 1. The dorsal aspect of the pons (pontine tegmentum) is the most common site of brainstem involvement 1. Ventral pontine lesions, substantia nigra and dentate nuclei affection can also be found, but there is usually no supratentorial involvement.
Spinal cord signal anomalies can also be identified, with the cervical cord being the most commonly involved. In these cases, there is increased T2 signal throughout the entire spinal cord grey matter.
Possible differential considerations include
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- 3. McMinn P, Stratov I, Nagarajan L, Davis S. Neurological manifestations of enterovirus 71 infection in children during an outbreak of hand, foot, and mouth disease in Western Australia. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 32 (2): 236-42. doi:10.1086/318454 - Pubmed
- 4. Linlin Li, Yaqing He, Hong Yang, Junping Zhu, Xingye Xu, Jie Dong, Yafang Zhu, Qi Jin. Genetic Characteristics of Human Enterovirus 71 and Coxsackievirus A16 Circulating from 1999 to 2004 in Shenzhen, People's Republic of China. Journal of Clinical Microbiology. 43 (8): 3835. doi:10.1128/JCM.43.8.3835-3839.2005 - Pubmed
Related Radiopaedia articles
Infections of the central nervous system
- classification by etiology
- Eastern equine encephalitis
- enterovirus rhombencephalitis
- flavivirus encephalitis
- herpes virus family
- HIV CNS manifestations
- HTLV-1-associated myelopathy
- JC virus
- measles encephalitis
- Nipah virus (NiV) encephalitis
- rabies encephalitis
- CNS listeriosis (Listeria monocytogenes)
- CNS nocardiosis (Nocardia spp)
- CNS tuberculosis (Mycobacterium tuberculosis)
- Lyme disease (Borrelia burgdorferi)
- neurobrucellosis (Brucella sp.)
- neurosyphilis (Treponema pallidum)
- Rocky Mountain spotted fever (Rickettsia rickettsii)
- cerebral amoebiasis
- cerebral malaria (Plasmodium falciparum)
- cerebral sparganosis (Spirometra mansonoides)
- neurocysticercosis (Taenia solium)
- neurohydatidosis (Echinococcus spp)
- neurotoxoplasmosis (Toxoplasma gondii)
- Creutzfeldt-Jakob disease (sporadic, variant, familial, and iatrogenic)
- fatal familial insomnia
- Gerstmann-Straussler-Scheinker disease
- variably protease-sensitive prionopathy
- others or those with possible infectious etiologies
- classification by location
- classification by etiology