Imaging Spectrum of Herpes Encephalitis In Paediatric Brain

Abstract IDNo: 90

Case 1:

11 yrs old female child who presented with fever of 6 days duration and two generalized tonic–clonic seizures. MR imaging on 1.5-T magnet was performed 7 days after symptom onset.

MR images:

T2 & FLAIR hyperintensities involving bilateral inferior frontal lobe, perinsular cortex and left medial temporal lobe and posterior corpus callosum.

- Features consistent with hemorrhagic herpetic encephalitis .

MR Shows:

Same patient came after 18 months with similar episode and MR was performed

MR shows: Well cortically enhancing T2 hyperintense lesions in the

bilateral inferior frontal cortex and insular cortex with cortical swelling.

Massive non enhancing edema involving the left supratentorial white matter , basal ganglia causing mass effect and midline shift with subfalcine herniation.

- possibility of recurrent atypical form of herpes encephalitis

Chronic Granulomatous Herpes Simplex – Encephalitis.

Pt undergone biopsy and biopsy was proven to be:

Patient was treated and follow up MR was done:

Compares to the previous one, present MRI show,  Same pattern of enhancing lesion with mild

reduced mass effect & midline shift.

-- Chronic Herpes Simplex – Encephalitis.

Case 2:

9-month-old female infant who presented with fever, lethargy, generalized tonic–clonic seizures one episode and decreased oral intake of 3 days duration. Initial MR images on 1.5-T magnet were performed 5 days after symptom onset.

MR Images:

Bilateral symmetric diffusion restricted lesions in the anterior temporal region, frontoparietal region and lateral aspect of thalamus (geniculate bodies).

- features suggestive of Herpes simplex encephalitis.

Pt was treated and follow up MR in 20 days shows:

Bilateral symmetric gliosis foci in the anterior temporal region& superior temporal gyri& periinsular cortex.Chronic areas of hemorrhagic with gliosis in the lateral aspect of both thalamus (geniculate bodies).

- No new lesions.

Case 3:

5-month-old male infant who presented with upper respiratory symptoms and fever of 4 days duration and single focal motor seizure on day of admission. MR imaging with 1.5-T magnet was performed 5 days after symptom onset.

Cortical swelling with areas of hemorrhages in the left frontoparietal cortex and left anterior temporal cortex.

s/o hemorrhagic encephalitis – Possible herpes encephalitis.

2-month-old male infant who presented with fever of 4 days duration and single focal motor seizure on day of admission. MR imaging with 1.5-T magnet was performed 3 days after symptom onset.

Case 4:

Bilateral asymmetrical diffusion restriction lesion involving both mesial temporal, uncus, hippocampal, basifrontal, left anterolateral temporal, bilateral periinsula, left posterior thalamic, genu of corpus callosum and posterior temporal region.

- features suggestive of herpes encephalitis.

MR shows:

Follow up MR shows:

-- No focal lesion or gliotic changes.

References:

M. A. ADAMO, L. ABRAHAM, AND I. F. POLLACK, “CHRONIC GRANULOMATOUS HERPES ENCEPHALITIS: a rare entity posing a diagnostic challenge,” Journal of Neurosurgery, vol. 8, pp. 402–406, 2011.

WILLIAM B. RADCLIFFE, FAUSTINO C. GUINTO, DAVID F. ADCOCK, MARTIN R. KRIGMAN: American Journal of Roentgenology. 1971;112:263-272. 10.2214/ajr.112.2.263.

Take Home Message: Though Herpes encephalitis appears

to be treatable cause,early diagnosis and prompt treatment required to prevent permanent brain damage and its sequelae…