Original articleChronological diffusion-weighted imaging changes and mutism in the course of rotavirus-associated acute cerebellitis/cerebellopathy concurrent with encephalitis/encephalopathy
Introduction
Rotavirus is the primary cause of severe gastroenteritis in children. Infection is basically localized in the intestine, but rare cases with morbidity result from extra-intestinal involvement. Several reports have discussed patients with rotavirus gastroenteritis coexisting with encephalitis/encephalopathy [1]. Patients with rotavirus diarrhea, benign or severe convulsions, or encephalitis have evidence of rotavirus in the cerebrospinal fluid (CSF) [2], [3]. Although rotavirus antigenemia is frequently observed in a patient’s serum during the acute phase [4], the CSF is not always positive for rotavirus antigen or PCR product [5]. The pathophysiological mechanism is still unclear. Although cerebellar disorders sometimes occur as a complication of rotavirus gastroenteritis in Japan, few reports about these issues have appeared [6], [7]. Here, we report three cases of rotavirus-associated acute cerebellitis/cerebellopathy with concurrent encephalitis/encephalopathy, focusing on chronological diffusion-weighted imaging changes and cerebellar mutism.
Section snippets
Case 1
An 18-month-old boy was referred to our hospital because of frequent diarrhea and vomiting for 2 days. Although he had started to walk independently at 14 months of age, he had been unable to speak any meaningful words and could not follow verbal instructions. On admission (day 0), his heart rate was 162 beats/min, respiratory rate 48 breaths/min, and body temperature was 38.2 °C. He had cyanotic lips and peripheral coldness. Additionally, he occasionally had episodes of loss of consciousness for
Discussion
The most striking findings in this report are the chronological DWI changes. Our patients mainly experienced an insulted cerebellum in addition to the encephalitis/encephalopathy associated with rotavirus. Patients presented with similar symptoms, i.e., apnea in the acute phase, mutism in the subacute phase, and DWI abnormalities characterized by marked hyperintensity in the bilateral dentate nucleus, followed by hyperintensity in the vermis and cerebellar hemispheres. Acute cerebellitis is
Acknowledgements
We appreciate helpful, advice by Kenji Yokochi, MD, Seirei-Mikatabara General Hospital; Takeshi Tsuji and Fumio Hayakawa, Okazaki City Hospital; and all members of Tokai Pediatric Neurology Group.
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