Tohru Okanishi1, Hiroyuki Yamamoto2, Takatoshi Hosokawa3, Naoki Ando4, Yoshihisa Nagayama5, Yuji Hashimoto6, Toshiro Maihara7, Tomohide Goto8, Tetsuo Kubota9, Chiharu Kawaguchi10, Hiroshi Yoshida11, Katsumi Sugiura12, Seiko Itomi13, Koyo Ohno14, Jun-ichi Takanashi15, Masahiro Hayakawa16, Hiroshi Otsubo17, Akihisa Okumura18. 1. Department of Child Neurology, Seirei-Hamamatsu General Hospital, Japan; Department of Pediatrics, Nagoya City University Graduate School of Medicine, Japan. Electronic address: okanishipediatrics@gmail.com. 2. Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan. 3. Department of Pediatrics, Kochi Medical School, Japan. 4. Department of Pediatrics, Nagoya City University Graduate School of Medicine, Japan. 5. Maternal and Perinatal Care Center, Niigata City General Hospital, Japan. 6. Department of Pediatrics, Chiba Kaihin Municipal Hospital, Japan. 7. Department of Pediatrics, Hyogo Prefectural Tsukaguchi Hospital, Japan. 8. Division of Neurology, Tokyo Metropolitan Children's Medical Center, Japan. 9. Department of Pediatrics, Anjo Kosei Hospital, Japan. 10. Department of Pediatrics, Nara City Hospital, Japan. 11. Department of Pediatrics, Tsuruoka Municipal Shonai Hospital, Japan. 12. Department of Pediatrics, Yamada Red Cross Hospital, Japan. 13. Department of Pediatrics, Japanese Red Cross Nagoya Daiichi Hospital, Japan. 14. Department of Pediatrics, Tottori Prefectural Central Hospital, Japan. 15. Department of Pediatrics, Kameda Medical Center, Japan. 16. Maternity and Perinatal Care Center, Nagoya University Hospital, Japan. 17. Department of Neurophysiology, Division of Neurology, The Hospital for Sick Children, Canada. 18. Department of Pediatrics, Aichi Medical University, Japan.
Abstract
AIM: To determine the early changes and evolutions of brain diffusion-weighted imaging (DWI), and analyze prognostic factors of the early changes among patients with neonatal herpes simplex encephalitis (NHSE). METHOD: We selected patients who developed encephalitis by 28 d after birth; had herpes simplex infection; and who underwent magnetic resonance imaging, including DWI, ⩽7 d of symptom onset. Thirty-two DWI scans between 0 and 28 d after onset in 13 patients and the clinical data were recruited. The distribution, evolution of the lesions, and neurological outcome were analyzed. RESULTS: DWI frequently showed multiple cortical lesions in both hemispheres in the early period and both hemispheres on DWI (8/9 scans at ⩽48 h, 7/7 patients). As time from onset increased, the cortical lesions tended to coincide with subcortical white matter lesions beneath the initial cortical lesions (p<0.01). Lesions from the cortex extended to the subcortical white matter in 7 patients. Deep cerebral lesions, involving basal ganglia, internal capsules, thalamus, were also found in 9 patients ⩽7 d of onset. The distributions of deep cerebral lesions (none/unilateral/bilateral) ⩽7 d of onset showed significant correlations with neurological prognoses (gross motor functions: p<0.01; developmental or intellectual quotient scores: p<0.01). INTERPRETATION: Cortical lesions were main findings of DWI in NHSE in the early period. Bilateral deep cerebral lesions ⩽7 d were highly indicative of poor motor and cognitive outcomes.
AIM: To determine the early changes and evolutions of brain diffusion-weighted imaging (DWI), and analyze prognostic factors of the early changes among patients with neonatal herpes simplex encephalitis (NHSE). METHOD: We selected patients who developed encephalitis by 28 d after birth; had herpes simplex infection; and who underwent magnetic resonance imaging, including DWI, ⩽7 d of symptom onset. Thirty-two DWI scans between 0 and 28 d after onset in 13 patients and the clinical data were recruited. The distribution, evolution of the lesions, and neurological outcome were analyzed. RESULTS: DWI frequently showed multiple cortical lesions in both hemispheres in the early period and both hemispheres on DWI (8/9 scans at ⩽48 h, 7/7 patients). As time from onset increased, the cortical lesions tended to coincide with subcortical white matter lesions beneath the initial cortical lesions (p<0.01). Lesions from the cortex extended to the subcortical white matter in 7 patients. Deep cerebral lesions, involving basal ganglia, internal capsules, thalamus, were also found in 9 patients ⩽7 d of onset. The distributions of deep cerebral lesions (none/unilateral/bilateral) ⩽7 d of onset showed significant correlations with neurological prognoses (gross motor functions: p<0.01; developmental or intellectual quotient scores: p<0.01). INTERPRETATION: Cortical lesions were main findings of DWI in NHSE in the early period. Bilateral deep cerebral lesions ⩽7 d were highly indicative of poor motor and cognitive outcomes.
Authors: Tarun D Singh; Jennifer E Fugate; Sara Hocker; Eelco F M Wijdicks; Allen J Aksamit; Alejandro A Rabinstein Journal: J Neurol Date: 2015-11-14 Impact factor: 4.849
Authors: Dara Petel; Michelle Barton; Christian Renaud; Lynda Ouchenir; Jason Brophy; Jennifer Bowes; Sarah Khan; Ari Bitnun; Jane McDonald; Andrée-Anne Boisvert; Joseph Ting; Ashley Roberts; Joan L Robinson Journal: BMC Pediatr Date: 2020-05-26 Impact factor: 2.125