title: Neurologic Manifestations of Enterovirus 71 Infection in Korea.
abstract: Enterovirus 71 frequently involves the central nervous system and may present with a variety of neurologic manifestations. Here, we aimed to describe the clinical features, magnetic resonance imaging (MRI) findings, and cerebrospinal fluid (CSF) profiles of patients presenting with neurologic complications of enterovirus 71 infection. We retrospectively reviewed the records of 31 pediatric patients hospitalized with acute neurologic manifestations accompanied by confirmed enterovirus 71 infection at Ulsan University Hospital between 2010 and 2014. The patients' mean age was 2.9 ± 5.5 years (range, 18 days to 12 years), and 80.6% of patients were less than 4 years old. Based on their clinical features, the patients were classified into 4 clinical groups: brainstem encephalitis (n = 21), meningitis (n = 7), encephalitis (n = 2), and acute flaccid paralysis (n = 1). The common neurologic symptoms included myoclonus (58.1%), lethargy (54.8%), irritability (54.8%), vomiting (48.4%), ataxia (38.7%), and tremor (35.5%). Twenty-five patients underwent an MRI scan; of these, 14 (56.0%) revealed the characteristic increased T2 signal intensity in the posterior region of the brainstem and bilateral cerebellar dentate nuclei. Twenty-six of 30 patients (86.7%) showed CSF pleocytosis. Thirty patients (96.8%) recovered completely without any neurologic deficits; one patient (3.2%) died due to pulmonary hemorrhage and shock. In the present study, brainstem encephalitis was the most common neurologic manifestation of enterovirus 71 infection. The characteristic clinical symptoms such as myoclonus, ataxia, and tremor in conjunction with CSF pleocytosis and brainstem lesions on MR images are pathognomonic for diagnosis of neurologic involvement by enterovirus 71 infection.
authors.affiliation: Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea .
authors.forename: Kyung Yeon
authors.identifier: 0000-0001-6821-1056
authors.initials: KY
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea .
authors.forename: Myoung Sook
authors.identifier: 0000-0001-7313-5676
authors.initials: MS
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea .
authors.forename: Dong Bin
authors.identifier: 0000-0002-7006-3934
authors.initials: DB
authors.lastname: Kim
mesh_terms: D000208:Acute Disease; D001921:Brain / Q000000981:diagnostic imaging; D002493:Central Nervous System Diseases / Q000209:etiology / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D004660:Encephalitis / Q000473:pathology; D029821:Enterovirus A, Human / Q000235:genetics / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000188:drug therapy / Q000473:pathology* / Q000821:virology; D005243:Feces / Q000821:virology; D005260:Female; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage; D007223:Infant; D007275:Injections, Intravenous; D007962:Leukocytes / Q000166:cytology; D007964:Leukocytosis / Q000134:cerebrospinal fluid / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D012367:RNA, Viral / Q000235:genetics / Q000378:metabolism; D060888:Real-Time Polymerase Chain Reaction; D056910:Republic of Korea; D012189:Retrospective Studies; D012621:Seasons
chemical_list: D007136:Immunoglobulins; D012367:RNA, Viral
keywords: Brain Stem; Cerebrospinal Fluid; Child; Enterovirus A, Human; Korea; Magnetic Resonance Imaging; Neurologic Manifestations