J Korean Med Sci.  2016 Apr;31(4):561-567. 10.3346/jkms.2016.31.4.561.

Neurologic Manifestations of Enterovirus 71 Infection in Korea

• Lee KY
• Lee MS
• Kim DB

• KMID: 2363695
• DOI: http://doi.org/10.3346/jkms.2016.31.4.561

Abstract

Enterovirus 71 frequently involves the central nervous system and may present with a variety of neurologic manifestations. Here, we aimed to describe the clinical features, magnetic resonance imaging (MRI) findings, and cerebrospinal fluid (CSF) profiles of patients presenting with neurologic complications of enterovirus 71 infection. We retrospectively reviewed the records of 31 pediatric patients hospitalized with acute neurologic manifestations accompanied by confirmed enterovirus 71 infection at Ulsan University Hospital between 2010 and 2014. The patients' mean age was 2.9 ± 5.5 years (range, 18 days to 12 years), and 80.6% of patients were less than 4 years old. Based on their clinical features, the patients were classified into 4 clinical groups: brainstem encephalitis (n = 21), meningitis (n = 7), encephalitis (n = 2), and acute flaccid paralysis (n = 1). The common neurologic symptoms included myoclonus (58.1%), lethargy (54.8%), irritability (54.8%), vomiting (48.4%), ataxia (38.7%), and tremor (35.5%). Twenty-five patients underwent an MRI scan; of these, 14 (56.0%) revealed the characteristic increased T2 signal intensity in the posterior region of the brainstem and bilateral cerebellar dentate nuclei. Twenty-six of 30 patients (86.7%) showed CSF pleocytosis. Thirty patients (96.8%) recovered completely without any neurologic deficits; one patient (3.2%) died due to pulmonary hemorrhage and shock. In the present study, brainstem encephalitis was the most common neurologic manifestation of enterovirus 71 infection. The characteristic clinical symptoms such as myoclonus, ataxia, and tremor in conjunction with CSF pleocytosis and brainstem lesions on MR images are pathognomonic for diagnosis of neurologic involvement by enterovirus 71 infection.

Keyword

Enterovirus A, Human; Neurologic Manifestations; Brain Stem; Magnetic Resonance Imaging; Cerebrospinal Fluid; Child; Korea

MeSH Terms

Acute Disease
Brain/diagnostic imaging
Central Nervous System Diseases/etiology/*pathology
Child
Child, Preschool
Encephalitis/pathology
Enterovirus A, Human/genetics/*isolation & purification
Enterovirus Infections/drug therapy/*pathology/virology
Feces/virology
Female
Humans
Immunoglobulins/administration & dosage
Infant
Injections, Intravenous
Leukocytes/cytology
Leukocytosis/cerebrospinal fluid/pathology
Magnetic Resonance Imaging
Male
RNA, Viral/genetics/metabolism
Real-Time Polymerase Chain Reaction
Republic of Korea
Retrospective Studies
Seasons
Immunoglobulins
RNA, Viral

Figure

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  Fig. 1 Seasonal distribution of neurologic complications by enterovirus 71 infection.

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  Fig. 2 Magnetic resonance imaging findings in the brain. Note the high signal intensity lesion in the posterior portion of the pons and bilateral dentate nuclei of the cerebellum on the axial T2-weighted images in (A) and (B) (arrows). Note the leptomeningeal enhancement of both cerebral hemispheres on contrast-enhanced T1-weighted images in (C) (arrowheads).

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