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. 2024 Jul:156:99-105.
doi: 10.1016/j.pediatrneurol.2024.03.035. Epub 2024 Apr 5.

Radiological Features of Herpetic Encephalitis in Children

Thai Son Pham  1 , Federico Montini  2 , Hoang Nhat Pham  3 , Minh-Thu Nguyen Tran  1 , Nguyen Tien Huy  4 , Laura Cacciaguerra  5 , Massimo Filippi  6
Affiliations

Radiological Features of Herpetic Encephalitis in Children

Thai Son Pham et al. Pediatr Neurol. 2024 Jul.

Abstract

Background: Nonspecific clinical manifestations and unclear radiological features may delay treatment initiation in pediatric patients with Herpes simplex encephalitis (HSE). The aim of this study is to analyze the clinical and radiological features of the disease.

Methods: Clinical, laboratory, and magnetic resonance imaging (MRI) data were obtained retrospectively from a group of 37 hospitalized pediatric patients older than two months and with a polymerase chain reaction-confirmed HSE diagnosis. Clinical severity (i.e., mechanical ventilatory support) and outcome at discharge (i.e., pediatric modified Rankin Scale [ped-mRS]) were also assessed.

Results: Median age was 14 months (interquartile range: 10-36). All patients survived, 15 (41%) had complete recovery (i.e., ped-mRS = 0), and 10 (27%) had significant residual disability at discharge (i.e., ped-mRS ≥3). Brain MRI was obtained in 31 patients. T2-hyperintense lesions were usually bilateral (28, 90%) and multifocal (30, 97%). Hemorrhage and mass effect were observed in 13 (42%) and 15 (48%) patients, respectively. Parenchymal lesions involved the temporal lobes (94%), insula (90%), parietal lobes (84%), and frontal lobes (61%). Occipital lesions were rare. In multivariable binary logistic regression models the presence of altered consciousness was associated with mechanical ventilation (odds ratio [OR] = 8.2, Nagelkerke R2 = 0.22), whereas the involvement of the occipital lobes (OR = 7.8) and the administration of vasopressors (OR = 12.1) were independent predictors of poor outcome (Nagelkerke R2 = 0.41).

Conclusions: Brain MRI is useful for diagnosis and outcome assessment in pediatric HSE. Radiological patterns with common frontotemporal involvement overlap adults, but multifocal and parietal lobe abnormalities are observed as well.

Keywords: Herpetic encephalitis; MRI; Pediatric; Prognosis.

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Conflict of interest statement

Declaration of competing interest Thai Son Pham, Federico Montini, Hoang Nhat Pham, Minh-Thu Nguyen Tran, and Tien Huy Nguyen report no disclosures. Laura Cacciaguerra received speaker and consultant honoraria from ACCMED, Biomedia, Roche, BMS Celgene, and Sanofi and travel support for conferences by Merck Serono. Massimo Filippi is Editor-in-Chief of the Journal of Neurology, is Associate Editor of Human Brain Mapping, Neurological Sciences, and is Associate Editor of Radiology. He received compensation for consulting services from Alexion, Almirall, Biogen, Merck, Novartis, Roche, and Sanofi; for speaking activities from Bayer, Biogen, Celgene, Chiesi Italia SpA, Eli Lilly, Genzyme, Janssen, Merck-Serono, Neopharmed Gentili, Novartis, Novo Nordisk, Roche, Sanofi, Takeda, and TEVA; for participation in Advisory Boards for Alexion, Biogen, Bristol-Myers Squibb, Merck, Novartis, Roche, Sanofi, Sanofi-Aventis, Sanofi-Genzyme, and Takeda; and for scientific direction of educational events for Biogen, Merck, Roche, Celgene, Bristol-Myers Squibb, Lilly, Novartis, and Sanofi-Genzyme; he receives research support from Biogen Idec, Merck-Serono, Novartis, Roche, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, and ARiSLA (Fondazione Italiana di Ricerca per la SLA).

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