Imaging Changes and Neurologic Outcome in a Patient with Murray Valley Encephalitis (MVE)

Description

The severity of encephalitis in Murray Valley Encephalitis Virus (MVEV) infection is associated with the extent of changes seen on MRI. Speers et al used MRI changes to predict outcome in affected patients. The authors are from multiple institutions in Western Australia.

MVEV is transmitted by mosquitoes in Western Australia.

Clinical and laboratory features of patients with MVE:

(1) altered mental status

(2) seizures

(3) tremor

(4) weakness and/or paralysis

(5) elevated CRP

(6) variable acute liver injury with elevated liver function tests

(7) variable thrombocytosis and neutrophilia

MRI changes are usually absent at disease onset but evolve over time depending on the severity of the infection.

Changes on MRI During the Acute Phase	Neurologic Outcome
none or minimal	excellent
absence of thalamic hyperintensity with or without leptomeningeal enhancement	good
unilateral or bilateral thalamic hyperintensity on T2 and FLAIR	moderate deficits
extension from thalami to involve the globus pallidi, red nucleus, substantia nigra	moderate to severe deficits
widespread changes in thalami, brainstem, cortical and subcortical structures, cerebellum	devastating with quadriparesis or brain death

MRI performed weeks or months later may show permanent damage in affected structures of the brain.

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Description

Specialty

ICD-10