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MR and CT imaging patterns in post-varicella encephalitis

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Abstract

The aim of the investigation was to determine the patterns of cerebral involvement on computed tomography (CT) and magnetic resonance (MR) imaging in post-varicella encephalitis. Four children between the ages of 2 and 11 years presented over a 5-year period with a diagnosis of post-varicella encephalitis. Their imaging studies and clinical data were reviewed retro-spectively. The medical histories of all four children were noncontributory except for recent bouts of chickenpox 1 week to 3 months prior to hospitalization. Three children presented with parkinsonian manifestations. Bilateral, symmetric hypodense, nonenhancing basal ganglia lesions were found on CT. These areas showed nonenhancing low signal intensity on T1-weighted images and high signal intensity on T2-weighted images on MR. One child presented with diffuse, multiple gray and white matter lesions of similar imaging characteristics; some lesions, however, did enhance. This child had no gait disturbances. Post-varicella encephalitis can produce two patterns of dramatic CT and MR findings. With an appropriate history and clinical findings, varicella as a cause of bilateral basal ganglia or diffuse cerebral lesions can be differentiated from other possible etiologies which include trauma, anoxia, metabolic disorders and demyelinating diseases.

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References

  1. Guess HA, Broughton DD, Melton LJ III, Kurland LT (1986) Population-based studies of varicella complications. Pediatrics 78:723–727

    PubMed  Google Scholar 

  2. Barnes DW, Whitley RJ (1986) CNS diseases associated with varicella zoster virus and herpes simples virus infection. Pathogenesis and current therapy. Neurol Clin 4:265–283

    PubMed  Google Scholar 

  3. Bauman ML, Bergman I (1984) Postvaricella encephalitis. Arch Neurol 41:556–558

    PubMed  Google Scholar 

  4. Preblud SR, Orenstein WA, Bart KJ (1984) Varicella: clinical manifestations, epidemiology and health impact in children. Pediatr Infect Dis 3:505–509

    PubMed  Google Scholar 

  5. Fleisher G, Henry W, McSorley M, Arbeter A, Plotkin S (1981) Life-threatening complications of varicella. Am J Dis Child 135:896–899

    PubMed  Google Scholar 

  6. Guess HA, Broughton DD, Melton LJ III, Kurland LT (1984) Chickenpox hospitalizations among residents of Olmsted Country, Minnesota, 1962 through 1981. A population-based study. Am J Dis Child 138:1055–1057

    PubMed  Google Scholar 

  7. Jackson MA, Burry VF, Olson LC (1992) Complications of varicella requiring hospitalization in previously healthy children. Pediatr Infect Dis J 11:441–445

    PubMed  Google Scholar 

  8. Krywanio ML (1991) Varicella encephalitis. J Neurosci Nurs 23:363–368

    PubMed  Google Scholar 

  9. Preblud SR (1986) Varicella: complications and costs. Pediatrics 78:728–735

    PubMed  Google Scholar 

  10. Straus SE (1988) Varicella-zoster virus infections. Ann Intern Med 108:221–237

    PubMed  Google Scholar 

  11. Anonymous (1992) Cerebrovascular complications of primary herpes varicella-zoster infection (editorial). Lancet 339:1449–1450

    Google Scholar 

  12. Rantala H, Uhari M, Uhari M, Saukkonen A, Sorri M (1991) Outcome after childhood encephalitis. Dev Med Child Neurol 33:858–867

    PubMed  Google Scholar 

  13. Morgan ER, Smalley LA (1983) Varicella in immunocompromised children. Incidence of abnormal pain and organ involvement. Am J Dis Child 137:883–885

    PubMed  Google Scholar 

  14. Rich J (1985) Varicella encephalitis. J Emerg Nurs 11:122–124

    PubMed  Google Scholar 

  15. Shulman ST (1985) Acyclovir treatment of disseminated varicella in childhood malignant neoplasms. Am J Dis Child 139: 137–140

    PubMed  Google Scholar 

  16. Maguire JF, Meissner HC (1985) Onset of encephalitis early in the course of varicella infection. Pediatr Infect Dis J 4:699–701

    Google Scholar 

  17. Leis AA, Butler IJ (1987) Infantile herpes zoster ophthalmicus and acute hemiparesis following intrauterine chickenpox. Neurology 37:1537–1538

    PubMed  Google Scholar 

  18. Miller DH, Kay R, Schon F, McDonald WI, Haas LF, Hughes RA (1986) Optic neuritis following chickenpox in adults. J Neurol 233:182–184

    PubMed  Google Scholar 

  19. McCarthy JT, Amer J (1978) Post-varicella acute transverse myelitis: a case presentation and review of the literature. Pediatrics 62:202–204

    PubMed  Google Scholar 

  20. Ross J, Milbourn PE (1970) Central nervous system manifestations of chickenpox. Can. Med Assoc J 102:831–834

    PubMed  Google Scholar 

  21. Liu GT, Urion DK (1992) Pre-eruptive varicella encephalitis and cerebellar ataxia. Pediatr Neurol 81:69–70

    Article  Google Scholar 

  22. Preblud SR (1981) Age-specific risks of varicella complications. Pediatrics 68:14–17

    PubMed  Google Scholar 

  23. Aronson MD, Phillips CF, Gump DW, Albertini RJ, Phillips CA (1976) Vidarabine therapy for severe herpes virus infections. An unusual syndrome of chronic varicella and transient immunologic deficiency. JAMA 235:1339–1342

    Article  PubMed  Google Scholar 

  24. Gershon A, Steinberg S, Greenberg S, Taber L (1980) Varicella-zoster-associated encephalitis: detection of specific antibody in cerebrospinal fluid. J Clin Microbiol 12:764–767

    PubMed  Google Scholar 

  25. Kennedy PG, Barrass JD, Graham DI, Clements GB (1990) Studies on the pathogenesis of neurological diseases associated with Varicella-zoster virus. Neuropathol Appl Neurobiol 16:305–316

    PubMed  Google Scholar 

  26. Peters AC, Versteeg J, Lindeman J, Bots GT (1978) Varicella and acute cerebellar ataxia. Arch Neurol 35:769–711

    PubMed  Google Scholar 

  27. Caekebeke JF, Peters AC, Vandvik B, Brouwer OF, deBakker HM (1990) Cerebral vasculopathy associated with primary varicella infection. Arch Neurol 47:1033–1035

    PubMed  Google Scholar 

  28. Grose C, (1986) Pathogenesis of central nervous system disease caused by varicella virus. Pediatr Infect Dis J 5:607–608

    Google Scholar 

  29. Shuper A, Vining EP, Freeman JM (1990) Central nervous system vasculitis after chickenpox-cause or coincidence? Arch Dis Child 65:1245–1248

    PubMed  Google Scholar 

  30. Shaw DW, Cohen WA (1993) Viral infections of the CNS in children: imaging features. AJR 160: 125–133

    PubMed  Google Scholar 

  31. Koskiniemi M, Vaheri A (1989) Effects of measles, mumps, rubella vaccination on pattern of encephalitis in children. Lancet 1:31–34

    Article  PubMed  Google Scholar 

  32. Barkovich AJ (1990) Pediatric neuroimaging, Raven, New York, pp 35–75

    Google Scholar 

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Darling, C.F., Larsen, M.B., Byrd, S.E. et al. MR and CT imaging patterns in post-varicella encephalitis. Pediatr Radiol 25, 241–244 (1995). https://doi.org/10.1007/BF02011086

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