Encephalopathy with extensive reversible restricted diffusion within the white matter or other problem?
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LETTER TO THE EDITOR
Encephalopathy with extensive reversible restricted diffusion within the white matter or other problem? Sora Yasri1 · Viroj Wiwanitkit2 Received: 30 January 2019 / Accepted: 28 February 2019 © Belgian Neurological Society 2019
Dear Editor, we read the publication on “Influenza-associated encephalopathy with extensive reversible restricted diffusion within the white matter” with a great interest [1]. Kirat et al. mentioned for the clinical association between influenza and encephalopathy with extensive reversible restricted diffusion within the white matter. We agree with that possible association. Clinically, encephalopathy with extensive reversible restricted diffusion within the white matter is a sporadically reported neurological problem. This condition is generally diagnosed by neuroimaging investigation. The lesion is usually detected by MRI investigation and the common finding is diffuse high-signal intensity on T2-weighted images. The lesion might extend in several areas of central nervous system and bilateral [2]. The patient might first present with neurological lesion, but there is usually a recovery with no neurological, cognitive, or neuropsychiatric deficit during following-up [2]. This problem is more common in children compared to adult [3]. Regarding influenza infection, the abnormal neuroimaging is possible. In a recent report by Ishida et al., the abnormal brain imaging could be detected in 32% of the patients. Regarding white matter involvement, 1 of 207 patients in the report by Ishida et al. had this problem [4]. Specific encephalopathy with extensive reversible restricted diffusion within the white matter is an uncommon type of white matter involvement in influenza. It is a possible complication in both influenza A and B infections [3–5]. The lesion is usually observed at subcortical area and splenium of corpus callosum [3, 4]. The neurological problem usually fully recovers after the treatment of influenza regardless of Sora Yasri and Viroj Wiwanitkit have contributed equally to this work.
specific neurological treatment [3–5]. The prognosis is usually good [6]. Nevertheless, there are also other possible conditions that might lead to the same clinical problem. The possible causes include infection, metabolic disorder, as well as hypertensive disorder [3]. The direct cytotoxic injury to the myelin might cause this clinical problem [2]. The possible pathogenesis of this disorder is intramyelic edema or inflammation due to cytokine response to infection [6, 7]. For the present case report, there are other possible causes of the neurological finding. Of several conditions, Epstein–Barr virus (EBV) encephalitis might have similar clinical feature [8]. The concurrent infection between influenza and EBV is also possible [9]. A clinical work-up to rule out this condition is required. For other uncommon infections, respiratory syncytial virus infection and parainfluenza virus infection might also cause of the neuropathological condition [10, 11]. We hereby would like to give
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