Table 1.
Previous studies on MRI characteristics of EV71 induced brainstem encephalitis.
Table 2.
Results of demographics data, clinic data and MRI findings.
Fig 1.
The diagram showed the location of primary lesion of brainstem encephalitis induced by EV71, which was a longitudinal lesion at the posterior junction region of the pons and medulla oblongata.
Fig 2.
Acute stage typeⅠ.Female, 3 years old, on the 9th day of the disease.
Sagittal MR images revealed a longitudinal lesion at the posterior junction region of the pons and medulla oblongata, with prolonged T1 (A, white arrow) and prolonged T2 (B, black arrow) signal, without enhancement (C, white arrow). See follow-up study in Fig 9.
Fig 3.
Male 20 months old. Sagittal T1WI (A) appeared normal. A patchy lesion with prolonged T2 signal was revealed on sagittal T2WI (B, black arrow), with mild enhancement (C, white arrow).
Fig 4.
Acute stage type Ⅲ, Female, 2.5 years old, on the 7th day of the disease.
There was no abnormal signal at the brainstem seen from sagittal T1WI (A) and T2WI (B); Post-contrast sagittal T1WI demonstrated a patchy, moderate enhancement region (C, white arrow).
Fig 5.
Acute stage type IV, Male, 6 months old, on the 6th day of the disease.
There was no abnormal signal at the brainstem seen from sagittal T1WI (A). T2WI showed a hypo-intensive lesion at the posterior junction region of the pons and medulla (B, black arrow), which had moderate enhancement (C, white arrow).
Fig 6.
Acute stage type V, Male, 28 months old, on the 11th day of the disease.
Whole brain stem was involved in this case, from midbrain to medullar oblongata, demonstrating as prolonged T1 (A) and prolong T2 signal (B, black arrow), without enhancement (C). This subject was hospitalized in PICU for 20 days, and final discharged. Follow-up study showed that there were neurologic sequealae, presenting as irregular breath and extremities tremor during sleeping.
Fig 7.
Convalescence Stage, Male, 4 years old, on the 28th day of the disease.
MR images showed there is a longitudinalmalacia cavity at the posterior junction region of the pons and medulla, with prolonged T1 (A, white arrow) and prolonged T1 (B, black arrow) signal, without enhancement (C, white arrow). This subject had had impaired function of breath and recurrent pneumonia after discharge.
Fig 8.
Postmortem stage, Male, 37 months old, on the 2nd day of the disease.
Sagittal FALIR (A, black arrow) and axial T2WI (B, black arrow) showed the whole posterior portion of the brainstem was involved, demonstrating hyper-intensive signal, with restricted diffusion (C, black arrow).
Fig 9.
Follow-up study of previous case (Female, 6 years 8 months old,from Fig 2) in 3 years 8 months.
Sagittal MR images revealed the lesion was smaller while compared with Fig 2, demonstrating prolonged T1 (A, white arrow) and prolonged T2 (B, black arrow) signal, and hyper-intensive signal on FLAIR(C, white arrow). This subject had special neurological sequelae, which were irregular breath and involuntary extremity tremor during sleeping at night.