DOI QR코드

DOI QR Code

Leptomeningeal Enhancement without Thalamic Involvement as an Initial Manifestation of Japanese Encephalitis: A Case Report

시상 침범 없는 연수막 조영증강을 보인 일본뇌염: 증례 보고

  • Sang Hwa Woo (Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Ho-Joon Lee (Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine) ;
  • Yeonah Kang (Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine)
  • 우상화 (인제대학교 의과대학 해운대백병원 영상의학과) ;
  • 이호준 (인제대학교 의과대학 해운대백병원 영상의학과) ;
  • 강연아 (인제대학교 의과대학 해운대백병원 영상의학과)
  • Received : 2020.05.07
  • Accepted : 2020.08.02
  • Published : 2021.03.01

Abstract

Japanese encephalitis (JE) is a common infection caused by the Japanese encephalitis virus in Southeast Asia, which is transmitted to humans through Culex mosquitoes. Magnetic resonance imaging (MRI) is used to diagnose JE, which is often characterized by the presence of bilateral symmetric thalamic involvement. Here, we report a rare case of JE characterized by leptomeningeal enhancement without thalamic involvement. This leptomeningeal enhancement disappeared with the treatment; however, new non-specific multifocal and bilateral high signal intensities in the cerebral white matter were found on follow-up MRI.

일본뇌염은 동남아시아에서 일본뇌염 바이러스에 의해 발생하는 흔한 감염이며, Culex 모기에 의해 인간으로 전파된다. 일본뇌염에서의 자기공명영상은 양측의 시상 침범이 있는 것이 흔한 소견이다. 저자들은 시상 침범 없이 연수막 조영증강의 형태로 나타난 일본뇌염의 드문 증례에 대해 보고하고자 한다. 치료 후, 연수막 조영증강은 사라졌으며, 비특이적인 다발성 및 양측의 고신호강도가 추적 MRI 영상에서 새롭게 나타났다.

Keywords

References

  1. Mehra S, Garga UC. Role of imaging in herpes and Japanese encephalitis-two cases and review of literature. J Indian Acad Clin Med 2012;13:338-343
  2. Misra UK, Kalita J. Overview: Japanese encephalitis. Prog Neurobiol 2010;91:108-120 https://doi.org/10.1016/j.pneurobio.2010.01.008
  3. Misra UK, Kalita J. Prognosis of Japanese encephalitis patients with dystonia compared to those with parkinsonian features only. Postgrad Med J 2002;78:238-241 https://doi.org/10.1136/pmj.78.918.238
  4. Kalita J, Misra UK, Mani VE, Bhoi SK. Can we differentiate between herpes simplex encephalitis and Japanese encephalitis? J Neurol Sci 2016;366:110-115 https://doi.org/10.1016/j.jns.2016.05.017
  5. Burke DS, Nisalak A. Detection of Japanese encephalitis virus immunoglobulin M antibodies in serum by antibody capture radioimmunoassay. J Clin Microbiol 1982;15:353-361 https://doi.org/10.1128/jcm.15.3.353-361.1982
  6. Smirniotopoulos JG, Murphy FM, Rushing EJ, Rees JH, Schroeder JW. Patterns of contrast enhancement in the brain and meninges. Radiographics 2007;27:525-551 https://doi.org/10.1148/rg.272065155
  7. Fukuoka H, Hirai T, Okuda T, Shigematsu Y, Sasao A, Kimura E, et al. Comparison of the added value of contrast-enhanced 3D fluid-attenuated inversion recovery and magnetization-prepared rapid acquisition of gradient echo sequences in relation to conventional postcontrast T1-weighted images for the evaluation of leptomeningeal diseases at 3T. AJNR Am J Neuroradiol 2010;31:868-873 https://doi.org/10.3174/ajnr.A1937
  8. Dung NM, Turtle L, Chong WK, Mai NT, Thao TT, Thuy TT, et al. An evaluation of the usefulness of neuroimaging for the diagnosis of Japanese encephalitis. J Neurol 2009;256:2052-2060 https://doi.org/10.1007/s00415-009-5249-5
  9. Shoji H, Kida H, Hino H, Matsuura S, Kojima K, Abe T, et al. Magnetic resonance imaging findings in Japanese encephalitis. White matter lesions. J Neuroimaging 1994;4:206-211 https://doi.org/10.1111/jon199444206
  10. Sarji SA, Abdullah BJ, Goh KJ, Tan CT, Wong KT. MR imaging features of Nipah encephalitis. AJR Am J Roentgenol 2000;175:437-442 https://doi.org/10.2214/ajr.175.2.1750437