TABLE 2

Neuroimaging, EEG features, and Outcome of Infants With Parechovirus Encephalitis Recruited to the ACE Study

CaseNeuroimaging (Day of Illness)EEGDischarge Outcome: GOS12-mo Outcome: ASQ
1Cranial ultrasound (d2): normal.Abnormal: Formal normal; subclinical epileptic discharges on continuous EEG monitoring.5; nil/minor sequelaeSignificant concern:
MRI (d15): Appearance: Subtle T2 hyperintense, diffusion restriction.Quantitative: gross motor subscale.
Distribution: Splenium corpus callosum and right occipital WM.Qualitative: uses legs “less well” than arms.
2Cranial ultrasound (d6): normal.Not done.5; nil/minor sequelaeSome concern:
MRI (d8): Appearance: T2 hyperintense, diffusion restriction.Qualitative: favors right arm; walks on toes.
Distribution: Bilateral periventricular WM and genu corpus callosum.
3Cranial ultrasound (d2): normal.Not done.5; nil/minor sequelaeNo concern.
4Cranial U/S (d4): Cystic changes in the caudothalamic groove bilaterally.Abnormal: frequent sharp activity over vertex and right temporal region.5; nil/minor sequelaeSome concern:
Qualitative: not yet walking; sister was walking at same age.
5MRI (d3): Appearance: T2 hyperintense, diffusion restriction.Abnormal: diffuse attenuation of background; most marked over the left hemisphere where brief, subclinical epileptic discharges seen.4; moderate sequelaeSignificant concern:
Distribution: Most supratentorial WM and parieto-occipital cortex + precentral gyrus of frontal lobe; bilateral thalami.Quantitative: communication, gross motor, fine motor, problem-solving and personal-social subscales.
MRS: decreased NAA, increased choline, no definite lactate peak.Qualitative: “frustrated easily.” Diagnosed with central visual impairment.
6Cranial ultrasound (d2): normal.Abnormal: epileptic discharges from both hemispheres, most subclinical, several arising from right temporal region.4; moderate sequelaeNil follow-up achieved.
MRI (d3): Appearance: T2 hyperintense, diffusion restriction.
Distribution: Most supratentorial WM (periventricular, deep + subcortical + corpus callosum), parieto-occipital cortex + precentral gyrus of frontal lobe; bilateral thalami show evidence of hemorrhage (T2 hypointense, T1 hyperintense).
MRS: decreased NAA, increased choline, lactate peak.
7MRI (d2): Appearance: T2 hyperintense, diffusion restriction.Abnormal: background slowing and multifocal epileptiform discharges.4; moderate sequelaeSignificant concern:
Distribution: Bilateral cerebral hemispheres, subcortical WM (especially frontal) and periventricular WM; small subarachnoid hemorrhage.Quantitative: gross motor and problem-solving subscales. “Some concern” on fine motor subscale.
MRS: widespread lactate peak.Qualitative: “frustrated easily,” difficult to settle. Diagnosed with left ocular “squint,” mild left-sided weakness.
8Cranial ultrasound (d7): abnormalAbnormal: multifocal epileptiform discharges.5; nil/minor sequelaeSignificant concern:
MRI (d11): Appearance: T2 hyperintense, diffusion restriction.Quantitative: gross motor and problem-solving subscales. “Some concern” on communication, fine motor, personal-social subscales.
Distribution: Bilateral, extensive periventricular WM, corpus callosum, and bilateral thalami.Qualitative: diagnosed with cerebral palsy, ocular “squint,” “frustrated easily.”
9Cranial ultrasound (d3): abnormal.Not done.5; nil/minor sequelaeSignificant concern:
MRI (d10): Appearance: T2 hyperintense, diffusion restriction, areas of necrosis and hemorrhage.Quantitative: communication, gross motor, problem-solving, and personal-social subscales. “Some concern” on fine motor subscale.
Distribution: Bilateral, extensive peri-ventricular WM, corpus callosum, bilateral thalami, cerebellar peduncles, hippocampi.Qualitative: diagnosed with cerebral palsy, ocular “squint,” “frustrated easily.”