MRI key to diagnosis, treatment of paediatric encephalitis

Magnetic resonance imaging (MRI) plays a significant role in the diagnosis and therapy of infectious encephalitis in children, according to a 10-year study. Thus, MRI should be implemented and made more accessible in this population.

“Paediatric encephalitis is a heterogeneous entity with nonspecific clinical and laboratory findings, with undefined aetiologies in most times,” the investigators said.

While infectious encephalitis represents a rare but potentially severe clinical condition, limited international data are available in paediatric age. To address this gap in knowledge, a retrospective study was conducted. Specifically, the investigators reviewed the clinical presentation; laboratory, radiology, and neurophysiology findings; the correlations between these exams and outcome; and the therapy performed.

Of the 56 patients (mean age 4.7 years, interquartile range, 0.7–8.7 years, 39.6 percent female) included in the study, 19.6 percent presented neurologic sequelae. The single most frequently isolated pathogen was herpes simplex virus (19.6 percent).

Some 41.1 percent of the children presented prodromal prior to the development of neurologic signs. Fever was the most common constitutional symptom, occurring in 83.9 percent. Cerebrospinal fluid was normal in nearly half of the patients (48.5 percent) and electroencephalography in about one in four children (24.5 percent).

Additionally, normal brain computed tomography scans were seen in 33 (91.7 percent) patients, while cerebral MRI exhibited pathologic findings in 62.5 percent of cases. Notably, MRI was the only parameter that correlated with neurologic sequelae (odds ratio, 8.1 95 percent confidence interval, 1.52–42.84; p=0.01).

“Further studies are needed to define the exact role and timing of steroids,” the investigators said.