title: MRI-imaging and clinical findings of eleven children with tick-borne encephalitis and review of the literature.
abstract: OBJECTIVE
  The incidence of tick-borne encephalitis (TBE) is increasing in many countries. Magnetic resonance imaging (MRI) in the course of TBE is not regularly performed in children. The aim of our study was evaluating MRI-findings of children and adolescents with TBE.
  
  
  METHODS
  Retrospective evaluation of the charts and MRIs of patients who had been treated for TBE in the four participating hospitals in the last twenty years.
  
  
  RESULTS
  11 patients (5 male; age at TBE 3 weeks-15 9/12 years; mean 104.9 months) were included. MRI (within the first week after admission) revealed symmetric or asymmetric T2-hyperintensities in both thalami in 7/11 patients with additional bilateral lesions in putamen and/or caudate nucleus in 3 patients, and additional cortical lesions in 2 patients. Our youngest patient presented with T2-hyperintensities affecting the whole left cerebral hemisphere including white and grey matter and both cerebellar hemispheres. One patient had a minimal reversible T2-hyperintensity in the splenium of the corpus callosum (RHSCC). 3/11 patients had a normal MRI. 4/11 patients showed complete neurological recovery (2/4 with a normal MRI, RHSCC patient). 6/11 children survived with significant sequelae: hemiparesis (n = 4); cognitive deficits (n = 4); pharmacoresistant epilepsy (n = 2). One patient died of a malignant brain edema.
  
  
  CONCLUSIONS
  A spectrum of MRI findings can be found in children with TBE, often showing involvement of the subcortical deep grey matter structures. In children presenting with a meningoencephalitis and bilateral thalamic involvement TBE should be included in the differential diagnosis.
authors.affiliation: Hospital for Neuropediatrics and Neurological Rehabilitation, Epilepsy Center for Children and Adolescents, Schön Klinik Vogtareuth, Krankenhausstr. 20, 83569 Vogtareuth, Germany; Institute for Transition, Rehabilitation and Palliation in Children and Adolescents, Paracelsus Medical University Salzburg, Muellner Hauptstr. 48, 5020 Salzburg, Austria. Electronic address: cvstuelpnagel@steinbeis.co.
authors.forename: C
authors.initials: C
authors.lastname: von Stülpnagel
authors.affiliation: Hospital for Neuropediatrics and Neurological Rehabilitation, Epilepsy Center for Children and Adolescents, Schön Klinik Vogtareuth, Krankenhausstr. 20, 83569 Vogtareuth, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Winkler
authors.affiliation: Department of Pediatrics, Paracelsus Medical University Salzburg, Muellner Hauptstr. 48, 5020 Salzburg, Austria.
authors.forename: J
authors.initials: J
authors.lastname: Koch
authors.affiliation: Hospital for Neuropediatrics and Neurological Rehabilitation, Epilepsy Center for Children and Adolescents, Schön Klinik Vogtareuth, Krankenhausstr. 20, 83569 Vogtareuth, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Zeches-Kansy
authors.affiliation: Hospital for Neuropediatrics and Neurological Rehabilitation, Epilepsy Center for Children and Adolescents, Schön Klinik Vogtareuth, Krankenhausstr. 20, 83569 Vogtareuth, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Schöttler-Glas
authors.affiliation: Children's Hospital Traunstein, Academic Teaching Hospital of Ludwig-Maximilians-University Munich, Cuno-Niggl-Straße 3, 83278 Traunstein, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Wolf
authors.affiliation: Institute for Medical Microbiology and Hygiene, University Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
authors.forename: H H
authors.initials: HH
authors.lastname: Niller
authors.affiliation: Hospital for Neuropediatrics and Neurological Rehabilitation, Epilepsy Center for Children and Adolescents, Schön Klinik Vogtareuth, Krankenhausstr. 20, 83569 Vogtareuth, Germany; Department for Neuropediatrics and Developmental Neurology, University Hospital for Children and Adolescents, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Staudt
authors.affiliation: Hospital for Neuropediatrics and Neurological Rehabilitation, Epilepsy Center for Children and Adolescents, Schön Klinik Vogtareuth, Krankenhausstr. 20, 83569 Vogtareuth, Germany; Institute for Transition, Rehabilitation and Palliation in Children and Adolescents, Paracelsus Medical University Salzburg, Muellner Hauptstr. 48, 5020 Salzburg, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Kluger
authors.affiliation: Department Pediatrics I, Neuropediatric Section, University Hospital LKH Innsbruck, Annichstr. 35, 6020 Innsbruck, Austria; Center for Neuropediatrics, Developmental Neurology and Social Pediatrics, Vestische Kinder- und Jugendklinik Datteln, University Witten-Herdecke, Dr.-Friedrich-Steiner-Straße 5, 45711 Datteln, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Rostasy
mesh_terms: D000293:Adolescent; D001929:Brain Edema / Q000209:etiology; D002421:Caudate Nucleus / Q000473:pathology; D002540:Cerebral Cortex / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000209:etiology; D003337:Corpus Callosum / Q000473:pathology; D000069279:Drug Resistant Epilepsy / Q000209:etiology; D004675:Encephalitis, Tick-Borne / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D010291:Paresis / Q000209:etiology; D011699:Putamen / Q000473:pathology; D012189:Retrospective Studies; D013788:Thalamus / Q000473:pathology; D016896:Treatment Outcome
keywords: Adolescents; Children; Encephalitis; MRI; TBE; Thalamic involvement