Elsevier

Brain and Development

Volume 33, Issue 1, January 2011, Pages 21-27
Brain and Development

Original article
Chronological diffusion-weighted imaging changes and mutism in the course of rotavirus-associated acute cerebellitis/cerebellopathy concurrent with encephalitis/encephalopathy

https://doi.org/10.1016/j.braindev.2010.04.007Get rights and content

Abstract

Rotavirus is one of the most common causes of gastroenteritis in children and is known to accompany some neurological disorders such as encephalitis/encephalopathy and seizures. Although cerebellar disorders sometime occur as a complication of rotavirus gastroenteritis in Japan, few reports have addressed these issues. Here, we report three cases of insulted cerebellums in addition to encephalitis/encephalopathy associated with rotavirus. Similar to posterior fossa syndrome after surgery, mutism was a notable symptom that lasted about 1 month. Brain diffusion-weighted imaging (DWI) revealed chronological changes, i.e., marked hyperintensity in the bilateral dentate nucleus followed by the vermis and cerebellar hemisphere. The bilateral dentate nucleus is known to be a key lesion site for mutism, and these clinical and radiological findings may be tightly connected in rotavirus-associated cerebellitis/cerebellopathy.

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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