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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 21:455-461 (3 2000)
© 2000 American Society of Neuroradiology

ARTICLE

Nipah Viral Encephalitis or Japanese Encephalitis? MR Findings in a New Zoonotic Disease

C. C. Tchoyoson Lim^,a, Yih Yian Sitoh^a, Francis Hui^a, Kim En Lee^a, Brenda S. P. Ang^a, Erle Lim^a, Winston E. H. Lim^a, Helen M. L. Oh^a, Paul A. Tambyah^a, Jill S. L. Wong^a, Chai Beng Tan^a and Thomas S. G. Chee^a

^a From the Departments of Neuroradiology (C.C.T.L., Y.Y.S., F.H.) and Neurology (K.E.L., C.B.T.), National Neuroscience Institute; the Department of Infectious Diseases, Communicable Disease Centre (B.S.P.A.) and the Department of Diagnostic Radiology (T.S.G.C.), Tan Tock Seng Hospital; the Departments of Neurology (E.L.) and Diagnostic Radiology (W.E.H.L.), Singapore General Hospital; the Department of Medicine, Changi General Hospital (H.M.L.O.); and the Departments of Medicine (P.A.T.) and Radiology (J.S.L.W.), National University Hospital, Singapore.

BACKGROUND AND PURPOSE: An epidemic of suspected Japanese encephalitis occurred in Malaysia in 1998–1999 among pig farmers. In neighboring Singapore, an outbreak occurred among pig slaughterhouse workers. It was subsequently established that the causative agent in the outbreak was not the Japanese encephalitis virus but a previously unknown Hendra-like paramyxovirus named Nipah virus.

METHODS: The brain MR images of eight patients with Nipah virus infection were reviewed. All patients tested negative for acute Japanese encephalitis virus. Seven patients had contrast-enhanced studies and six had diffusion-weighted examinations.

RESULTS: All patients had multiple small bilateral foci of T2 prolongation within the subcortical and deep white matter. The periventricular region and corpus callosum were also involved. In addition to white matter disease, five patients had cortical lesions, three had brain stem involvement, and a single thalamic lesion was detected in one patient. All lesions were less than 1 cm in maximum diameter. In five patients, diffusion-weighted images showed increased signal. Four patients had leptomeningeal enhancement and four had enhancement of parenchymal lesions.

CONCLUSION: The brain MR findings in patients infected with the newly discovered Nipah paramyxovirus are different from those of patients with Japanese encephalitis. In a zoonotic epidemic, this striking difference in the appearance and distribution of lesions is useful in differentiating these diseases. Diffusion-weighted imaging was advantageous in increasing lesion conspicuity.

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