Human parechovirus meningoencephalitis

Abstract

Human parechovirus-3 (HPeV-3) infection is one of the differential diagnoses of neonatal meningoencephalitis. A 13-day-old full-term female neonate presented with a seizure. Brain MRI showed classic imaging findings of the meningoencephalitis which was confirmed on cerebrospinal fluid analysis.

Contribution: The HPeV-3 is an emerging pathogen for neonatal meningoencephalitis. The case in this study is unique with classic imaging findings, which are not routinely encountered in day-to-day practice. This case raises reader awareness.

Keywords: CSF; MRI; human parechovirus; meningoencephalits; neonate.

FIGURE 1

(a, b, c) Axial diffusion-weighted MRI of the brain (repetition time msec/echo time msec, 8500/100; flip angle, 90°; b-value = 1000 sec/mm²) and (d, e, f) corresponding axial apparent diffusion coefficient maps (8500/100; flip angle, 90°; b-value = 1000 sec/mm²) at the level of the high frontal lobes (a, d), basal ganglia (b, e) and peritrigonal white matter (c, f). Areas of restricted diffusion involving the bilateral supratentorial white matter, predominantly bilateral frontal lobes (solid white arrows on all images), corpus callosum (dashed white arrows on images [b]) and [e]) and bilateral peritrigonal periventiruclar white matter (solid white arrow heads on images [b], [c], [e] and [f]).

FIGURE 2

Axial T2-weighted MRI of the brain (repetition time msec/echo time msec, 3680/90, 3-mm section thickness) at the level of the high frontal lobes (a), basal ganglia (b) and peritrigonal white matter (c). The images show areas of T2 signal abnormality involving the corpus callosum and the bilateral supratentorial white matter, predominantly the bilateral frontal regions (solid white arrows on all images) with sparing of the thalami.

FIGURE 3

Axial fluid-attenuated inversion recovery MRI of the brain (inversion time 2500, repetition time msec/echo time msec, 9000/112, 3-mm section thickness) at the level of the high frontal lobes (a), basal ganglia (b) and peritrigonal white matter (c). Images demonstrate areas of FLAIR signal abnormality involving the corpus callosum and the bilateral supratentorial white matter, predominantly the bilateral frontal regions (solid white arrows on all images) with sparing of the thalami.

FIGURE 4

Axial unenhanced T1-weighted MRI of the brain (repetition time msec/echo time msec, 300/2.52, 3-mm section thickness) at the level of centrum semiovale and corona radiata (a, b, c) with corresponding axial T2-weighted MRI of the brain (repetition time msec/echo time msec, 3680/90, 3-mm section thickness) (d, e, f). There were areas of T1 and T2 shortening following the distribution of deep medullary veins (solid white arrows on all images), more evident on the T1-weighted images.

FIGURE 5

Axial T1-weighted MRI of the brain at the level of centrum semiovale (repetition time msec/echo time msec, 300/2.52, 3-mm section thickness), unenhanced (a) and contrast-enhanced (b) after intravenous injection of 1 mL of gadoteridol (ProHance; Bracco). There were areas of non-enhancing signal abnormality in the bilateral supratentorial frontal white matter (solid white arrow heads on images [a] and [b]), corresponding to the restricted diffusion. Subtle leptomeningeal contrast enhancement seen (solid white arrows on image b).