Diffusion-weighted MRI for early diagnosis of neonatal herpes simplex encephalitis

作者：Okanishi Tohru^*; Yamamoto Hiroyuki; Hosokawa Takatoshi; Ando Naoki; Nagayama Yoshihisa; Hashimoto Yuji; Maihara Toshiro; Goto Tomohide; Kubota Tetsuo; Kawaguchi Chiharu; Yoshida Hiroshi; Sugiura Katsumi; Itomi Seiko; Ohno Koyo; Takanashi Jun ichi; Hayakawa Masahiro; Otsubo Hiroshi; Okumura Akihisa

来源：Brain & Development, 2015, 37(4): 423-431.

DOI：10.1016/j.braindev.2014.07.006

• Magnetic resonance imaging
• Cortical lesions
• Diffusion weighted imaging
• Herpes simplex encephalitis
• Early diagnosis
• Neonate

Aim: To determine the early changes and evolutions of brain diffusion-weighted imaging (DWI), and analyze prognostic factors of the early changes among patients with neonatal herpes simplex encephalitis (NHSE).
Method: We selected patients who developed encephalitis by 28 d after birth; had herpes simplex infection; and who underwent magnetic resonance imaging, including DWI, 7 d of symptom onset. Thirty-two DWI scans between 0 and 28 d after onset in 13 patients and the clinical data were recruited. The distribution, evolution of the lesions, and neurological outcome were analyzed.
Results: DWI frequently showed multiple cortical lesions in both hemispheres in the early period and both hemispheres on DWI (8/9 scans at <= 48 h, 7/7 patients). As time from onset increased, the cortical lesions tended to coincide with subcortical white matter lesions beneath the initial cortical lesions (p < 0.01). Lesions from the cortex extended to the subcortical white matter in 7 patients. Deep cerebral lesions, involving basal ganglia, internal capsules, thalamus, were also found in 9 patients 7 d of onset. The distributions of deep cerebral lesions (none/unilateral/bilateral) 7 d of onset showed significant correlations with neurological prognoses (gross motor functions: p <0.01; developmental or intellectual quotient scores: p <0.01).
Interpretation: Cortical lesions were main findings of DWI in NHSE in the early period. Bilateral deep cerebral lesions..<,7 d were highly indicative of poor motor and cognitive outcomes.

• 出版日期2015-4