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MR Imaging of Herpes Simplex Type I Encephalitis in Infants and Young Children

A Separate Pattern of Findings

Jeffrey R. Leonard1, Christopher J. Moran2, DeWitte T. Cross, III2, Franz J. Wippold, II2,3, Yechiel Schlesinger4 and Gregory A. Storch4

1 Department of Neurological Surgery, Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110.
2 Mallinckrodt Institute of Radiology, Washington University Medical Center, 510 S. Kingshighway Blvd., St. Louis, MO 63110.
3 Department of Radiology and Nuclear Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814.
4 Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110.



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  		Fig. 1A. —4-month-old male infant who presented with upper respiratory symptoms and fever of 4 days duration and single focal motor seizure on day of admission. MR imaging with 1.5-T magnet was performed 8 days after symptom onset. Unenhanced axial T1-weighted MR image (600/14[TR/TE]) shows area of hypointensity in white matter of left temporal—occipital region. Two small areas of hemorrhage involve gray—white junction.

 


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  		Fig. 1B. —4-month-old male infant who presented with upper respiratory symptoms and fever of 4 days duration and single focal motor seizure on day of admission. MR imaging with 1.5-T magnet was performed 8 days after symptom onset. Axial T2-weighted MR image (3500/90) shows hyperintensity in involved white matter.

 


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  		Fig. 2A. —7-month-old female infant who presented with generalized tonic—clonic seizure on day of admission. MR imaging with 1.0-T magnet was performed that day. Coronal T2-weighted MR image (2400/90 [TR/TE]) shows hyperintensity in right parietal and insular cortex and adjacent white matter.

 


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  		Fig. 2B. —7-month-old female infant who presented with generalized tonic—clonic seizure on day of admission. MR imaging with 1.0-T magnet was performed that day. Enhanced coronal T1-weighted MR image (800/22) shows mild enhancement in same areas as A.

 


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  		Fig. 3A. —11-month-old female infant who presented with fever, lethargy, left-sided focal motor seizures, and decreased oral intake of 3 days duration. Initial MR images on 1.0-T magnet were 7 days after symptom onset. Axial T2-weighted MR image (3000/90 [TR/TE]) shows hyperintensity in cortex, white matter of both parietal lobes (arrows), left insula (arrowheads), and both thalami. Left hemispheric findings are more apparent than those in right hemisphere.

 


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  		Fig. 3B. —11-month-old female infant who presented with fever, lethargy, left-sided focal motor seizures, and decreased oral intake of 3 days duration. Initial MR images on 1.0-T magnet were 7 days after symptom onset. Enhanced coronal T1-weighted MR image (800/22) shows enhancing cortex in both parietal lobes and insular regions.

 


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  		Fig. 3C. —11-month-old female infant who presented with fever, lethargy, left-sided focal motor seizures, and decreased oral intake of 3 days duration. Initial MR images on 1.0-T magnet were 7 days after symptom onset. Enhanced axial T1-weighted MR image (800/22) shows enhancement in cortex and white matter of both parietal lobes and insular regions and in left thalamus.

 


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  		Fig. 4A. —13-month-old female infant who presented with fever of 6 days duration and two generalized tonic—clonic seizures. MR imaging on 1.0-T magnet was performed 12 days after symptom onset. Unenhanced axial T1-weighted MR image (600/22 [TR/TE]) shows hypointensity in thickened cortex of both frontal and parietal lobes.

 


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  		Fig. 4B. —13-month-old female infant who presented with fever of 6 days duration and two generalized tonic—clonic seizures. MR imaging on 1.0-T magnet was performed 12 days after symptom onset. Enhanced axial T1-weighted MR image (600/22) shows no evidence of meningeal enhancement.

 


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  		Fig. 4C. —13-month-old female infant who presented with fever of 6 days duration and two generalized tonic—clonic seizures. MR imaging on 1.0-T magnet was performed 12 days after symptom onset. Axial T2-weighted MR image (2000/80) shows hyperintensity in cortex and adjacent white matter of both frontal and parietal lobes.

 

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