Neuroimaging Spectrum of Enterovirus Central Nervous System Infections in a Pediatric Population

Enteroviral infections range from self-limiting illnesses to severe neurological disorders. A thorough review of published literature reveals few studies highlighting the neuroimaging findings of such cases; however, none have been published from the Indian subcontinent. The present study analyzes the varied imaging and clinical spectrum of microbiologically proven cases of encephalomyelitis due to enterovirus in a tertiary care institute in northern India. This prospective study was conducted at a tertiary care institute in north India, and included 23 cases that presented with variable neurological symptoms of central nervous system infection and were found to have enterovirus, confirmed using reverse transcriptase-polymerase chain reaction. All these patients had undergone a brain magnetic resonance imaging (MRI). MRI spine was done depending on the symptoms of the patients. Imaging analysis was done by two experienced neuroradiologists. Fever was the most common presenting symptom, followed by altered sensorium and seizures. In neuroimaging, we found ganglio-capsular (13 cases, 56%), brain stem (7, 30%), cerebral hemisphere (6, 26%), and spinal cord (3, 13.04%) involvement. Basal ganglia and brainstem involvement was a common pattern seen in our cases, unlike the previously reported pattern of predominant posterior fossa structure involvement. As the pattern and site of both the spinal cord and the brain differ from previously published literature, further analysis would be needed to confirm the cause of such findings.