Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Department of Neurology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Neurol India. 2020 Sep-Oct;68(5):1038-1047. doi: 10.4103/0028-3886.294556.
Dengue can present with variable neurological complications including encephalitis, encephalopathy, acute disseminated encephalomyelitis (ADEM), and ischemic and hemorrhagic stroke. Our study describes a pattern-based approach to recognize different brain MRI findings in dengue-seropositive patients with neurological symptoms.
Thirty-six serologically proven dengue patients with neurological symptoms and undergoing brain MRI over a 6-month period were included in this study. The diagnosis of dengue encephalopathy or encephalitis was established by presence of signs/symptoms of acute encephalitic syndrome with the presence of Immunoglobin M (IgM) antibody against dengue antibody in the serum and/or presence of dengue antigen (NS1) in serum. The MRI brain along with diffusion weighted imaging and susceptibility weighted imaging sequences were evaluated by an experienced neuroradiologist.
Eleven patients had normal MRI finding. In the rest 25 patients, 12 were found to have encephalitic pattern, 4 had encephalopathic (seizure related/metabolic) pattern, 3 had features of ADEM, and isolated micro- or macro-hemorrhages were found in 6 patients. In the encephalitis group, eight had concomitant involvement of brainstem, cerebellum, and ganglio-thalamic complexes with additional involvement of cortex and subcortical white matter (WM) found in three. Isolated brainstem and cerebellar involvement were seen in three in this group, whereas one had isolated cerebellar involvement. Interspersed hemorrhage was noted in the structures involved in eight patients in encephalitis group.
Radiologists should be aware of various MRI brain findings in dengue and a pattern recognition approach often helps in reaching the correct diagnosis albeit after exclusion of other differentials based on laboratory studies.
登革热可引起多种神经并发症，包括脑炎、脑病、急性播散性脑脊髓炎（ADEM）以及缺血性和出血性中风。本研究描述了一种基于模式的方法，用于识别登革热血清阳性伴神经系统症状患者的不同脑部 MRI 表现。
本研究纳入了 36 例经血清学证实的登革热伴神经系统症状且在 6 个月内接受脑部 MRI 检查的患者。登革热脑病或脑炎的诊断依据为急性脑炎综合征的体征/症状，血清中存在针对登革热的免疫球蛋白 M（IgM）抗体，或血清中存在登革热抗原（NS1）。由经验丰富的神经放射科医生评估 MRI 脑部以及弥散加权成像和磁敏感加权成像序列。
11 例患者 MRI 正常。在其余 25 例患者中，12 例表现为脑炎模式，4 例表现为脑病（与癫痫相关/代谢性）模式，3 例表现为 ADEM 特征，6 例患者发现孤立的微出血或大出血。在脑炎组中，8 例伴有脑干、小脑和神经节-丘脑复合体受累，另外 3 例伴有皮质和皮质下白质（WM）受累。该组中有 3 例孤立的脑干和小脑受累，1 例孤立的小脑受累。在脑炎组的 8 例患者中，注意到在受累结构中存在散在性出血。
放射科医生应了解登革热的各种脑部 MRI 表现，并且即使在根据实验室研究排除其他不同病因后，基于模式识别的方法通常有助于做出正确诊断。
