Dengue encephalitis with predominant cerebellar involvement: Report of eight cases with MR and CT imaging features

• Published in: European radiology Vol. 25; no. 3; pp. 719 - 725
• Main Authors: Hegde, Vinay, Aziz, Zarina, Kumar, Sharath, Bhat, Maya, Prasad, Chandrajit, Gupta, A. K., Netravathi, M., Saini, Jitender
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-03-2015; Springer Nature B.V
• Subjects: Adolescent; Adult; Antibodies; Antigens; Basal Ganglia - pathology; Blood platelets; Brain - pathology; Brain Stem - pathology; Cerebellar Diseases - pathology; Cerebellum - pathology; Cerebral Cortex - pathology; Cerebral Hemorrhage - pathology; Child; Dengue - pathology; Dengue fever; Diagnostic Radiology; Encephalitis; Encephalitis, Arbovirus - pathology; Female; Glucose; Guillain-Barre syndrome; Humans; Imaging; Infections; Internal Capsule - pathology; Internal Medicine; Interventional Radiology; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Mental health; Neuro; Neuroradiology; Neurosciences; Proteins; Radiology; Retrospective Studies; Serology; Thalamus - pathology; Thrombocytopenia; Tomography, X-Ray Computed; Ultrasound; Young Adult; India; Encephalitis; Cerebellitis; Dengue infection; Microbleeds; MRI
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-014-3473-6

Objectives
CNS dengue infection is a rare condition and the pattern of brain involvement has not been well described. We report the MR imaging (MRI) features in eight cases of dengue encephalitis.
Materials and methods
We retrospectively searched cases of dengue encephalitis in which imaging was performed. Eight cases (three men, five women; age range: 8–42 years) diagnosed with dengue encephalitis were included in the study. MR studies were performed on 3-T and 1.5-T MR clinical systems. Two neuroradiologists retrospectively reviewed the MR images and analysed the type of lesions, as well as their distribution and imaging features.
Results
All eight cases exhibited MRI abnormalities and the cerebellum was involved in all cases. In addition, MRI signal changes were also noted in the brainstem, thalamus, basal ganglia, internal capsule, insula, mesial temporal lobe, and cortical and cerebral white matter. Areas of susceptibility, diffusion restriction, and patchy post-contrast enhancement were the salient imaging features in our cohort of cases.
Conclusion
A pattern of symmetrical cerebellar involvement and presence of microbleeds/haemorrhage may serve as a useful imaging marker and may help in the diagnosis of dengue encephalitis.
Key Points
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MR images of eight cases diagnosed with dengue encephalitis were retrospectively reviewed.
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Symmetrical cerebellar involvement may serve as an imaging marker on MRI.
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Presence of microbleeds/haemorrhage and diffusion restriction are other salient features.