7 days old term neonate with early onset sepsis, severe dehydration and seizure.
7 days old term neonate with early onset sepsis, severe dehydration, and seizure.
- Symmetrical areas of diffusion restriction involving periventricular white matter, corona radiata, corpus callosum, thalami and posterior limb of internal capsules.
- No significant T2 hyperintensity seen in above mentioned areas
- No evidence of hemorrhage
Diagnosis:
Rota viral encephalitis
Discussion:
- Rotavirus infection has been suggested as possible cause of ‘fifth day fits’ in 1990s by Herrmann et al.
- Mainly causes white mater injury seen as extensive and symmetrical diffusion restriction.
- Cystic evolution and neurological sequel can be seen
- The pattern of white matter injury seen in rotavirus infections is not unique and is, in fact, strikingly similar to that seen in neonatal enterovirus and parechovirus encephalitis.
- In all 3 infections, the major findings on cerebral imaging are diffuse high signal intensity in the white matter on T2-weighted sequences and restricted diffusion in the periventricular white matter, corpus callosum, and deep white matter.
- However, the signal changes seen on conventional MRI sequence are more subtle in the white matter injury of rotavirus infections than that related to enterovirus and parechovirus infections.
REFERENCES/ FURTHER READING:
Yeom JS, Park CH. White matter injury following rotavirus infection in neonates: new aspects to a forgotten entity, ‘fifth day fits’?. Korean Journal of Pediatrics. 2016;59(7): 285?291.
Dr. Suvarna Kote
Radiology Resident
Manipal Hospitals Radiology Group
Dr. Sriram Patwari
MD, PDCC (Neuroradiology)
Consultant Radiology, Co-lead Neuroradiology
Manipal Hospitals Radiology Group