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EBV delineating the corticospinal tract. Serviço de Neurorradiologia Hospital Garcia de Orta, E.P.E Lígia Neves ; Ricardo Pimentel, Rui de Carvalho; Miguel Grunho; Cristina Marques; Júlia Duarte. Introduction / Case Report / Discussion / Conclusion.

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ebv delineating the corticospinal tract

EBV delineating the corticospinal tract

Serviço de Neurorradiologia

Hospital Garcia de Orta, E.P.E

Lígia Neves; Ricardo Pimentel, Rui de Carvalho; Miguel Grunho; Cristina Marques; Júlia Duarte

introduction case report discussion conclusion
Introduction / Case Report / Discussion / Conclusion
  • Epstein-Barr virus (EBV) is the pathogen of infeccious mononucleosis, which usually is a benign and self-limited disease.
  • Although unusual, it may produce neurologic symptoms such as seizures, polyradiculomyelitis, transverse myelitis, encephalitis or cranial nerve palsies.
introduction case report discussion conclusion1
Introduction / Case Report / Discussion / Conclusion
  • Male, 40 years old.
  • Clinical presentation: acute tetraparesis, no reflexes, bilateral D4 sensitive level plus Kernig and Brudzinski signs, dysphagia and no pharyngeal reflex.
  • No inflammatory blood parameters.
slide4

Introduction / Case Report / Discussion / Conclusion

1.5T MRI - bilateral hiperintensity delineating the corticospinal tract

Coronal T2 FLAIR

Axial T2 FSE

slide5

Introduction / Case Report / Discussion / Conclusion

1.5T MRI - hiperintensity delineating the pyramidal tract in the ventral cordbetween segments D2-D10

Axial T2 FSE

slide6

Introduction / Case Report / Discussion / Conclusion

1.5T MRI - hiperintensity delineating the corticospinal tract in the ventral spinal cord between D2 and D10. No spinal cord swelling and no parenchymal or meningeal contrast enhancement

Sagittal T1 C+

Sagittal T2 FSE

slide7

Introduction / Case Report / Discussion / Conclusion

  • Lombar puncture revealed:
  • - pleocytosis
  • - increased protein levels
  • - decreased glucose levels
  • Polymerase chain reaction (PCR):
  • - genomic nucleic acids positive for EBV
slide8

Introduction / Case Report / Discussion / Conclusion

1.5T MRI - Partial T2 hiperintensity resolution after treatment with corticotherapy, ceftriaxone, acyclovir and plasmapheresis

Coronal T2 FLAIR

Sagittal T2 FSE

slide9

Introduction / Case Report / Discussion / Conclusion

  • In this case, the diagnosis of EBV infection was ascertained by PCR.
  • EBV can be presented with a wide spectrum of imaging abnormalities ranging from normal to diffuse signal intensity changes either in grey or white matter, sometimes resembling ADEM.
  • The particularity of this case is the distribution of signal intensities confined to the pyramidal tracts.
slide10

Introduction / Case Report / Discussion / Conclusion

  • This case demonstrates that EBV can be presented with a peculiar distribution of MR signal in CNS and therefore should be considered in otherwise unexplained pyramidal tract lesions cases.
slide11

References

1.G. Hagemann H.-J. Mentzel H. Weisser A. Kunze C. Terborg , Multiple Reversible MR Signal Changes Caused by Epstein-Barr Virus Encephalitis, AJNR Am J Neuroradiol 27:1447–49, Aug 2006

2. Mascalchi M, Tassinari C. Corticospinal tract degeneration in motor neuron disease, AJNR. 2995; 16: 878-880

3.Volpi A. Epstein-Barr virus and human herpesvirus type 8 infections of the central nervous system. Herpes 2004;11 (suppl 2):120A–27A

4.Fujimoto H, Asaoka K, Imaizumi T, et al. Epstein-Barr virus infections of the central nervous system. Intern Med 2003;42:33– 40