MR imaging findings of epidemic enterovirus 71 encephalitis in infants and young children

C. Y. Chen, Y. C. Chang, C. C. Huang, C. C. Lui, C. Y. Yu, J. G. Wan, Y. S. Yuh

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5 Citations (Scopus)


To investigate the magnetic resonance imaging (MRI) findings of acute neurological complications in infants and young children with enterovirus 71 (EV71) infections. MRI studies were obtained for 27 of 44 infants and young children who had acute encephalitic symptoms and positive EV71 isolations during an outbreak of hand, foot, and mouth disease in Taiwan from April through December 1998. Among the 27 patients with a total of 32 MRI studies (including five follow-up scans), 20 had abnormal T2 high-signal lesions in the brain stem and the other 7 were normal. The characteristic features of brain stem encephalitis encompassed myoclonic jerks, tremors, ataxia, cranial nerve palsy and, in seven severe cases, apnea and acute neurogenic cardiopulmonary collapse. Among 25 patients who had MRI during the acute stage of illness, 18 showed high signal T2-weighted lesions in the brain stem and/or upper cervical cord. The brain stem lesions observed on MRI were most commonly at the tegmentum of the pons (18/25, 72%) followed by tile medulla oblongata (15/25, 60%), and the midbrain which includes the tegmentum, substantia nigra and superior cerebellar peduncles (11/25, 44%). Abnormal signal intensities were also seen in dentate nuclei (8/25, 32%) and upper cervical cord (6/25, 24%). Follow-up MRI in five patients showed normal findings in four patients who had complete recovery, and brain stem atrophy and T2 high-signal abnormalities in the other who had residual deficits. MRI findings during tile chronic stage from two patients with prolonged ventilation who had survived from acute cardiopulmonary collapse showed necrosis of the midbrain, the tegmentum of the pons and the medulla oblongata. The MRI findings of EV71 brain stem encephalitis are unique. Young children with epidemic hand, foot, and mouth disease complicated with myoclonus, tremor, ataxia, oculomotor palsy or acute cardiopulmonary collapse should raise the suspicion of EV71 infection. MRI is particularly useful in the early detection of the brain stem lesions that may suggest the diagnosis of EV71 infection before the virus can be isolated.

Original languageEnglish
Pages (from-to)45-52
Number of pages8
JournalChinese Journal of Radiology
Issue number2
Publication statusPublished - 2000
Externally publishedYes


  • Brain stem encephalitis
  • Enterovirus 71 infection
  • Magnetic resonance imaging

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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