White matter injury following rotavirus infection in neonates: new aspects to a forgotten entity, 'fifth day fits'?

Abstract

That rotavirus infection can cause neurological symptoms in young children has been well established. However, it is surprising why rotavirus infection has been overlooked as a cause of neonatal seizures for many years, despite significant research interest in neonatal rotavirus infection. Neonates are the age group most vulnerable to seizures, which are typically attributed to a wide range of causes. By contrast, because rotavirus infection is usually asymptomatic, it has been difficult to identify an association between this virus and neonatal seizures. The conventional wisdom has been that, although neonates are commonly infected with rotavirus, neurological complications are rare in this age. However, recent studies using diffusion-weighted imaging (DWI) have suggested a connection between rotavirus infection and neonatal seizures and that rotavirus infection can induce diffuse white matter injury without direct invasion of the central nervous system. The clinical features of white matter injury in rotavirus-infected neonates include the onset of seizures at days 4-6 of life in apparently healthy term infants. The recent findings seem to contradict the conventional wisdom. However, white matter injury might not be a completely new aspect of rotavirus infection in neonates, considering the forgotten clinical entity of neonatal seizures, 'fifth day fits'. With increased use of DWI in neonatal seizures, we are just starting to understand connection between viral infection and white matter injury in neonates. In this review, we discuss the historical aspects of rotavirus infection and neonatal seizures. We also present the clinical features of white matter injury in neonatal rotavirus infection.

Keywords: Injuries; Newborn infant; Rotavirus; Seizures; White matter.

Fig. 1. Magnetic resonance imaging obtained 3 days after the onset of seizures in a term-newborns with seizures in 6th day and rotavirus infection. Diffusion-weighted imaging (A) and apparent diffusion coefficient map (B) show restricted diffusion in the periventricular white matter, corpus callosum, and optic radiation with symmetry. These findings were not apparent in T1-weighted spine echo sequence (C) and T2-weighted fluid-attenuated inversion recovery images (D) (unpublished data from Gyeongsang National University Hospital).

Fig. 2. Serial follow-up magnetic resonance imaging. (A) Cystic changes was observed in white matter in the frontal lobe at 2.5 months after seizure onset. (B) Note the decreased cerebral white matter volume at 2 years after onset of symptoms. Panels show T2-weighted fluid-attenuated inversion recovery image (A) and T1-weighted spine echo sequence (B) from a same patient who suffered neonatal seizures with rotavirus infection (unpublished data from Gyeongsang National University of Hospital).