Abstract
Neonatal encephalitis by either enteroviruses (EVs) or parechoviruses (PeVs) is often
complicated by hemispheric periventricular white matter lesions. Although showing
many similarities, the two types of encephalitis differ in some clinical and laboratory
aspects, mostly because PeV encephalitis does not show any change of protein and white
cell content in the cerebrospinal fluid, and clinically, the onset of PeV encephalitis
is often marked by early seizures accompanying a fever of sepsis-like disease. Instead,
no difference exists relative to the white matter lesions, which are constantly described
as periventricular, even in rare detailed neuropathological studies. Herein, taking
a cue from a neonate with EV encephalitis who showed occipital white matter lesions
involving the overlying cortex, but completely sparing the periventricular area, we
demonstrate that the brain lesions in EV encephalitis in newborns can be more extended
than known. To our knowledge, the not-periventricular involvement of the white matter
with EV encephalitis has never been described so far, as well as the potential of
EV to injure the cortex. We confirm the pathogenetic role of a vascular mechanism
for the tissue injury, but other proposed mechanisms are also discussed. It is noteworthy
that the neurological outcome of this newborn remained favorable, and no epileptic
seizures occurred in the first few days nor afterward.
Keywords
encephalitis - newborn -
Enterovirus
-
Parechovirus
- white matter
