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Research ArticlePEDIATRICS

Human Parechovirus Meningoencephalitis: Neuroimaging in the Era of Polymerase Chain Reaction–Based Testing

A. Sarma, E. Hanzlik, R. Krishnasarma, L. Pagano and S. Pruthi
American Journal of Neuroradiology July 2019, DOI: https://doi.org/10.3174/ajnr.A6118
A. Sarma
aFrom the University Medical Center (A.S., E.H., L.P., S.P.), Vanderbilt University, Nashville, Tennessee
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E. Hanzlik
aFrom the University Medical Center (A.S., E.H., L.P., S.P.), Vanderbilt University, Nashville, Tennessee
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R. Krishnasarma
bBoston Children's Hospital (R.K.), Harvard Medical School, Boston, Massachusetts.
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L. Pagano
aFrom the University Medical Center (A.S., E.H., L.P., S.P.), Vanderbilt University, Nashville, Tennessee
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S. Pruthi
aFrom the University Medical Center (A.S., E.H., L.P., S.P.), Vanderbilt University, Nashville, Tennessee
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Abstract

SUMMARY: Human parechovirus infection is an increasingly recognized cause of neonatal meningoencephalitis. We describe characteristic clinical features and brain MR imaging abnormalities of human parechovirus meningoencephalitis in 6 infants. When corroborated by increasingly available polymerase chain reaction–based testing of the CSF, the distinctive MR imaging appearance may yield a specific diagnosis that obviates costly and time-consuming further clinical evaluation. In our study, infants with human parechovirus presented in the first 35 days of life with seizures, irritability, and sepsis. MR imaging consistently demonstrated low diffusivity within the thalami, corpus callosum, and subcortical white matter with a frontoparietal predominance. T1 and T2 shortening connoting white matter injury along the deep medullary veins suggests venous ischemia as an alternative potential pathogenetic mechanism to direct neuroaxonal injury.

ABBREVIATIONS:

HPeV
human parechovirus
PCR
polymerase chain reaction

Footnotes

  • Disclosures: Asha Sarma—UNRELATED: Royalties: Cambridge University Press, Comments: textbook previously published on a different topic.

  • Data previously presented in a different format for oral presentation at: Society for Pediatric Radiology Annual Meeting and Categorical Course, April 30 to May 4, 2019; San Francisco, California.

  • © 2019 by American Journal of Neuroradiology
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Human Parechovirus Meningoencephalitis: Neuroimaging in the Era of Polymerase Chain Reaction–Based Testing
A. Sarma, E. Hanzlik, R. Krishnasarma, L. Pagano, S. Pruthi
American Journal of Neuroradiology Jul 2019, DOI: 10.3174/ajnr.A6118

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Human Parechovirus Meningoencephalitis: Neuroimaging in the Era of Polymerase Chain Reaction–Based Testing
A. Sarma, E. Hanzlik, R. Krishnasarma, L. Pagano, S. Pruthi
American Journal of Neuroradiology Jul 2019, DOI: 10.3174/ajnr.A6118
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