Sunday 8 September 2013

Measles Encephalitis MRI

 A 12 years old patient with characteristic morbiliform rash.
Admitted in our neuro institute with symptoms of encephalitis occurred 10 days after appearance of the rash, altered sensorial with lower limb flaccid paralysis now.
Csf report positive for specific IgM and IgG antibodies.  
Clinical diagnosis was measles encephalitis.

Here is her on admission MRI Brain Axial FLAIR, T2w and Diffusion. 
MRI Brain Axial FLAIR shows confluent bilateral cerebral white matter hyper intensity extending along external capsules with faint restricted diffusion. T2 w images show bilateral basal ganglionic  symmetric T2 hyper intensity with focal parenchymal swelling consistent with clinical diagnosis of measles encephalitis.
Imaging findings of Measles Encephalitis mentioned in literatures are 1. Multifocal high signal in bilateral cerebral hemispheres, swelling of the cortex, 2.  Bilateral, symmetrical involvement of the putamen and caudate nucleus, lesions showing low apparent diffusion coefficients. 3. Sub acute gyriform hemorrhage, asymmetrical gyriform contrast enhancement mentioned in severe cases. 4 Diffuse cerebral cortical atrophy, gliosis and encephalomalacic changes on follow up MRI studies. 

Histopathological findings of Measles Encephalitis mentioned in literatures are perivascular mononuclear cell infiltration, white matter demyelination, gliosis and intranuclear and intracytoplasmic eosinophilic inclusions in neuronal and glial cells in the temporal, parietal and occipital cortex as well as in the thalamus. 

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