title: Diffusion-weighted MRI for early diagnosis of neonatal herpes simplex encephalitis.
abstract: OBJECTIVE
  To determine the early changes and evolutions of brain diffusion-weighted imaging (DWI), and analyze prognostic factors of the early changes among patients with neonatal herpes simplex encephalitis (NHSE).
  
  
  METHODS
  We selected patients who developed encephalitis by 28 d after birth; had herpes simplex infection; and who underwent magnetic resonance imaging, including DWI, ⩽7 d of symptom onset. Thirty-two DWI scans between 0 and 28 d after onset in 13 patients and the clinical data were recruited. The distribution, evolution of the lesions, and neurological outcome were analyzed.
  
  
  RESULTS
  DWI frequently showed multiple cortical lesions in both hemispheres in the early period and both hemispheres on DWI (8/9 scans at ⩽48 h, 7/7 patients). As time from onset increased, the cortical lesions tended to coincide with subcortical white matter lesions beneath the initial cortical lesions (p<0.01). Lesions from the cortex extended to the subcortical white matter in 7 patients. Deep cerebral lesions, involving basal ganglia, internal capsules, thalamus, were also found in 9 patients ⩽7 d of onset. The distributions of deep cerebral lesions (none/unilateral/bilateral) ⩽7 d of onset showed significant correlations with neurological prognoses (gross motor functions: p<0.01; developmental or intellectual quotient scores: p<0.01).
  
  
  CONCLUSIONS
  Cortical lesions were main findings of DWI in NHSE in the early period. Bilateral deep cerebral lesions ⩽7 d were highly indicative of poor motor and cognitive outcomes.
authors.affiliation: Department of Child Neurology, Seirei-Hamamatsu General Hospital, Japan; Department of Pediatrics, Nagoya City University Graduate School of Medicine, Japan. Electronic address: okanishipediatrics@gmail.com.
authors.forename: Tohru
authors.initials: T
authors.lastname: Okanishi
authors.affiliation: Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yamamoto
authors.affiliation: Department of Pediatrics, Kochi Medical School, Japan.
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Hosokawa
authors.affiliation: Department of Pediatrics, Nagoya City University Graduate School of Medicine, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Ando
authors.affiliation: Maternal and Perinatal Care Center, Niigata City General Hospital, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nagayama
authors.affiliation: Department of Pediatrics, Chiba Kaihin Municipal Hospital, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Hashimoto
authors.affiliation: Department of Pediatrics, Hyogo Prefectural Tsukaguchi Hospital, Japan.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Maihara
authors.affiliation: Division of Neurology, Tokyo Metropolitan Children's Medical Center, Japan.
authors.forename: Tomohide
authors.initials: T
authors.lastname: Goto
authors.affiliation: Department of Pediatrics, Anjo Kosei Hospital, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Kubota
authors.affiliation: Department of Pediatrics, Nara City Hospital, Japan.
authors.forename: Chiharu
authors.initials: C
authors.lastname: Kawaguchi
authors.affiliation: Department of Pediatrics, Tsuruoka Municipal Shonai Hospital, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshida
authors.affiliation: Department of Pediatrics, Yamada Red Cross Hospital, Japan.
authors.forename: Katsumi
authors.initials: K
authors.lastname: Sugiura
authors.affiliation: Department of Pediatrics, Japanese Red Cross Nagoya Daiichi Hospital, Japan.
authors.forename: Seiko
authors.initials: S
authors.lastname: Itomi
authors.affiliation: Department of Pediatrics, Tottori Prefectural Central Hospital, Japan.
authors.forename: Koyo
authors.initials: K
authors.lastname: Ohno
authors.affiliation: Department of Pediatrics, Kameda Medical Center, Japan.
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Takanashi
authors.affiliation: Maternity and Perinatal Care Center, Nagoya University Hospital, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hayakawa
authors.affiliation: Department of Neurophysiology, Division of Neurology, The Hospital for Sick Children, Canada.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Otsubo
authors.affiliation: Department of Pediatrics, Aichi Medical University, Japan.
authors.forename: Akihisa
authors.initials: A
authors.lastname: Okumura
mesh_terms: D001921:Brain / Q000473:pathology*; D003071:Cognition; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D018450:Disease Progression; D042241:Early Diagnosis; D020803:Encephalitis, Herpes Simplex / Q000175:diagnosis* / Q000473:pathology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009043:Motor Activity; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires
keywords: Cortical lesions; Diffusion weighted imaging; Early diagnosis; Herpes simplex encephalitis; Magnetic resonance imaging; Neonate