MR Imaging Features of Nipah Encephalitis

Abstract

The newly discovered Nipah virus causes an acute febrile encephalitic illness in humans that is associated with a high mortality. The purpose of this study is to describe the MR imaging findings of Nipah encephalitis. MR imaging of the brain was performed in 31 patients with Nipah encephalitis divided into three groups. The first group (14 patients) underwent MR imaging during the acute phase of the illness and the second group (10 patients) during the later phase of the acute illness. The third group consisted of six patients who underwent MR imaging because they experienced neurologic relapse and one patient who had late-onset encephalitis. Spin-echo T1- and T2-weighted sequences and T2-weighted fluid attenuated inversion recovery (FLAIR) sequences were performed. Contrast-enhanced MR imaging was performed in four patients. The FLAIR sequences revealed abnormalities in all patients studied. MR imaging findings in both the acute and later phases of encephalitis were similar; the main feature of both phases was the presence of discrete high-signal-intensity lesions, measuring 2-7 mm, disseminated throughout the brain, mainly in the subcortical and deep white matter of the cerebral hemispheres. Neither mass effect nor cerebral edema was seen. There was no correlation with the focal neurologic signs, depth of coma, and outcome of the patients. The lesions were attributed to widespread microinfarctions from underlying vasculitis of cerebral small vessels. Features found on MR imaging in relapsed and late-onset encephalitis differed from the features in acute encephalitis in that confluent cortical involvement was the prominent finding in the former, as opposed to discrete focal lesions in the subcortical and deep white matter in the latter. MR imaging is a sensitive and specific diagnostic tool for evaluating Nipah encephalitis.