title: Neurological images and the predictors for neurological sequelae of epidemic herpangina/hand-foot-mouth disease with encephalomyelitis.
abstract: Since 1998 in Taiwan, enterovirus (EV) 71 epidemics have caused encephalomyelitis and placed a significant burden on parents and physicians. In this study, we present clinical manifestations, magnetic resonance (MR) imaging findings, and neurological sequelae on epidemic EV-infected patients with encephalomyelitis. Of the 46 patients, 14 patients presented with neurological sequelae; of them, 3 patients suffered from complications of mental regression. Predictors of unfavorable neurological sequelae were myoclonic jerks (> 4 times/night) and pleocytosis (167/μL) of the cerebrospinal fluid (CSF). Results from viral culture and MR imaging indicated that positive identification of EV71 infection was associated significantly with lesions on MR imaging. Our results show that hand-foot-mouth disease carries a higher risk of encephalomyelitis and that frequent myoclonic jerks and pleocytosis of the CSF are risk factors for subsequent neurological sequelae. Positive identification of EV71 might be useful as a predictor of lesions in MR imaging.
authors.affiliation: Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
authors.forename: Jeng-Dau
authors.initials: JD
authors.lastname: Tsai
authors.affiliation: Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Hung-Tsung
authors.initials: HT
authors.lastname: Kuo
authors.affiliation: Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
authors.forename: Shan-Ming
authors.initials: SM
authors.lastname: Chen
authors.affiliation: Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
authors.forename: Ko-Huang
authors.initials: KH
authors.lastname: Lue
authors.affiliation: Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan.
authors.forename: Ji-Nan
authors.initials: JN
authors.lastname: Sheu
mesh_terms: D002648:Child; D002675:Child, Preschool; D004679:Encephalomyelitis / Q000175:diagnosis* / Q000821:virology; D029821:Enterovirus A, Human; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D006557:Herpangina / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D012307:Risk Factors