Encephalitis associated with the chikungunya epidemic outbreak in Brazil: report of 2 cases with neuroimaging findings

Chikungunya, an alphavirus infection presenting with fever, rash, and polyarthritis, is most often an acute febrile illness. Neurologic complications of chikungunya infection have been reported. Here we report the clinical and neuroimaging data of 2 patients with chikungunya-associated encephalitis during the recent Brazilian epidemic.

Keywords:
Chikungunya vírus; Encephalitis; MRI

Authorship

Licia Pacheco Pereira

Divisão de Neurorradiologia, Departamento de Radiologia, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, CE, Brasil. Universidade Federal do CearáBrazilFortaleza, CE, BrazilDivisão de Neurorradiologia, Departamento de Radiologia, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, CE, Brasil.

Departamento de Radiologia, Hospital Geral de Fortaleza, Fortaleza, CE, Brasil. Hospital Geral de FortalezaBrazilFortaleza, CE, BrazilDepartamento de Radiologia, Hospital Geral de Fortaleza, Fortaleza, CE, Brasil.

Rafaela Villas-Bôas

Stephanie Suzanne de Oliveira Scott

Divisão de Neurologia, Departamento de Medicina Clínica, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, CE, Brasil. Universidade Federal do CearáBrazilFortaleza, CE, BrazilDivisão de Neurologia, Departamento de Medicina Clínica, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, CE, Brasil.

Paulo Ribeiro Nóbrega

Manoel Alves Sobreira-Neto

José Daniel Vieira de Castro

Bruno Cavalcante

Departamento de Medicina Clínica, Hospital Monte Klinikum, Fortaleza, CE, Brasil.Hospital Monte KlinikumBrasilFortaleza, CE, BrasilDepartamento de Medicina Clínica, Hospital Monte Klinikum, Fortaleza, CE, Brasil.

Pedro Braga-Neto

Corresponding author: Dra. Licia Pacheco Pereira. e-mail:liciap.luna@gmail.com

Conflict of interest: The authors declare that have no conflicts of interest.

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (3)

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FIGURE 1
Multiple supratentorial FLAIR (A) and DWI (B) hyperintense foci (arrowheads) distributed randomly in the white matter. Diffuse FLAIR hyperintense white matter was also noted on the centrum semiovale (arrows in A). FLAIR: Fluid-attenuated inversion recovery; DWI: Diffusion weighted imaging.

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FIGURE 2
The cortical and subcortical hyperintense foci (arrowheads) in DWI (A) show restricted water diffusion seen as hypointense areas on the ADC map (B). DWI: Diffusion weighted imaging; ADC: Apparent diffusion coefficient.

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FIGURE 3
(A): Normal brain MRI (2nd day of hospitalization). (B): Appearance of multiple FLAIR and DWI hyperintense foci (arrowheads) on the supratentorial white matter 5 days after the 1st MRI. The DWI hyperintensities are very subtle. (C): Brain MRI done 4 months later showing the persistence of some of the FLAIR hyperintensities (arrowheads), no longer noticed on DWI. FLAIR hyperintense regions on the parietal white matter were also noted, which partially disappeared on control MRI (arrows on B and C). MRI: Magnetic resonance imaging; FLAIR: Fluid-attenuated inversion recovery; DWI: Diffusion weighted imaging.

FIGURE 1 Multiple supratentorial FLAIR (A) and DWI (B) hyperintense foci (arrowheads) distributed randomly in the white matter. Diffuse FLAIR hyperintense white matter was also noted on the centrum semiovale (arrows in A). FLAIR: Fluid-attenuated inversion recovery; DWI: Diffusion weighted imaging.

FIGURE 2 The cortical and subcortical hyperintense foci (arrowheads) in DWI (A) show restricted water diffusion seen as hypointense areas on the ADC map (B). DWI: Diffusion weighted imaging; ADC: Apparent diffusion coefficient.

FIGURE 3 (A): Normal brain MRI (2nd day of hospitalization). (B): Appearance of multiple FLAIR and DWI hyperintense foci (arrowheads) on the supratentorial white matter 5 days after the 1st MRI. The DWI hyperintensities are very subtle. (C): Brain MRI done 4 months later showing the persistence of some of the FLAIR hyperintensities (arrowheads), no longer noticed on DWI. FLAIR hyperintense regions on the parietal white matter were also noted, which partially disappeared on control MRI (arrows on B and C). MRI: Magnetic resonance imaging; FLAIR: Fluid-attenuated inversion recovery; DWI: Diffusion weighted imaging.

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Encephalitis associated with the chikungunya epidemic outbreak in Brazil: report of 2 cases with neuroimaging findings

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[1] Corresponding author: Dra. Licia Pacheco Pereira. e-mail:liciap.luna@gmail.com