American Journal of Neuroradiology 26:1986-1995, September 2005
© 2005 American Society of Neuroradiology
BRAIN
West Nile Virus Meningoencephalitis: MR Imaging Findings
a Department of Radiology, Section of Neuroradiology, the Cleveland Clinic Foundation, Cleveland, OH
b Department of Infectious Diseases, the Cleveland Clinic Foundation, Cleveland, OH
c Department of Neuropathology, the Cleveland Clinic Foundation, Cleveland, OH
Address correspondence to Kalliopi A. Petropoulou, MD, Department of Radiological Sciences, Section of Neuroradiology, University of Oklahoma Health Sciences Center College of Medicine, P.O. Box 26901, Everett Tower, Room 1606, Oklahoma City, OK 73190
BACKGROUND AND PURPOSE: Reports of MR imaging in West Nile virus (WNV) meningoencephalomyelitis are few and the described findings limited. The purpose of this study was to review the spectrum of MR imaging findings for WNV meningoencephalomyelitis and investigate whether any of the findings correlates with clinical presentation of flaccid paralysis.
METHODS: We reviewed the MR imaging findings of 17 patients with confirmed WNV encephalitis and/or myelitis. MR imaging brain studies were evaluated for location of signal intensity abnormalities, edema, hydrocephalus, or abnormal enhancement. MR imaging spine studies were evaluated for signal intensity abnormalities in cord and/or enhancement.
RESULTS: Retrospective review of the MR imaging studies of 17 patients was performed by 2 neuroradiologists. Eleven of 16 brain MR images demonstrated abnormalities. Eight (50%) patients had abnormal studies related to meningoencephalitis. All 8 patients had abnormal findings in the deep gray matter and/or brain stem; 2 had additional white matter abnormalities. Three patients with abnormal MR studies of the spine had extremity weakness on examination. The imaging findings included abnormal signal intensity more pronounced in the ventral horns and/or enhancement around the conus medullaris and cauda equina. One patient had additional abnormalities in the pons.
CONCLUSION: Abnormal MR imaging findings in patients with WNV meningoencephalomyelitis are nonspecific but not uncommon. Anatomic areas commonly affected are basal ganglia, thalami, mesial temporal structures, brain stem, and cerebellum. Extremity weakness or flaccid paralysis corresponds to spinal cord/cauda equina abnormalities.
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