Non-congenital viral infections of the central nervous system: from the immunocompetent to the immunocompromised child
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PICTORIAL ESSAY
Non-congenital viral infections of the central nervous system: from the immunocompetent to the immunocompromised child Giulia Moltoni 1 & Felice D’Arco 2 & Luca Pasquini 1,3 & Chiara Carducci 3 & Aashim Bhatia 4 & Daniela Longo 3 & Marios Kaliakatsos 5 & Laura Lancella 6 & Andrea Romano 1 & Alberto Di Napoli 1 & Alessandro Bozzao 1 & Maria Camilla Rossi-Espagnet 1,3 Received: 30 December 2019 / Revised: 14 April 2020 / Accepted: 25 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Non-congenital viral infections of the central nervous system in children can represent a severe clinical condition that needs a prompt diagnosis and management. However, the aetiological diagnosis can be challenging because symptoms are often nonspecific and cerebrospinal fluid analysis is not always diagnostic. In this context, neuroimaging represents a helpful tool, even though radiologic patterns sometimes overlap. The purpose of this pictorial essay is to suggest a schematic representation of different radiologic patterns of non-congenital viral encephalomyelitis based on the predominant viral tropism and vulnerability of specific regions: cortical grey matter, deep grey matter, white matter, brainstem, cerebellum and spine. Keywords Central nervous system . Children . Encephalitis . Magnetic resonance imaging . Myelitis . Viral infection . Viral tropism
Introduction Central nervous system involvement by a viral infection is a severe complication associated with high morbidity and mortality [1]. Clinical manifestations of viral encephalitis are heterogeneous and nonspecific, including fever, headache, vomiting, seizures, focal deficits, lethargy or coma.
* Maria Camilla Rossi-Espagnet [email protected] 1
Neuroradiology Unit, NESMOS Department, Sapienza University, Rome, Italy
2
Neuroradiology Unit, Great Ormond Street Hospital, London, UK
3
Neuroradiology Unit, IRCCS Bambino Gesù Children’s Hospital, Piazza Sant’Onofrio 4, 00100 Rome, Italy
4
Neuroradiology Unit, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
5
Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
6
Pediatric and Infectious Diseases Unit, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
If there is spine involvement, motor/sensory disturbances and bowel/bladder disfunctions might be present. Moreover, both virus and host characteristics influence the probability of developing neurologic damage as well as its severity and location. Again, immunocompromised children or neonates and preterm infants with an immature immune system are more susceptible to viral infections and can develop severe brain injuries compared to immunocompetent children. The diagnosis of viral encephalitis is usually made by detection of virus deoxyribonucleic acid (DNA)/ribonucleic acid (RNA) by polymerase chain reaction analysis of cerebrospinal fluid. However, this analysis is sometimes inconclusive and requires time for results. In this clinical scenario, neuroimaging repre
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