CT and MRI findings of human herpesvirus 6-associated encephalopathy

Comparison with findings of herpes simplex virus encephalitis

Tomoyuki Noguchi, Takashi Yoshiura, Hiwatashi Akio, Osamu Togao, Koji Yamashita, Eiki Nagao, Akira Uchino, Kanehiro Hasuo, Kazushige Atsumi, Takashi Matsuura, Toshiro Kuroiwa, Futoshi Mihara, Hiroshi Honda, Sho Kudo

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE. It is important to differentiate human herpesvirus 6 (HHV-6)-associated encephalopathy from herpes simplex encephalitis (HSE). Although these conditions are similar with regard to involvement of the mesial temporal lobe, HSE is sensitive to acyclovir but HHV-6 encephalopathy is not. We compared the imaging findings of the two conditions. MATERIALS AND METHODS. We encountered eight cases of HHV-6 encephalopathy and nine cases of HSE. We divided an observation time into early, middle, and late periods defined as 0-2, 3-30, and more than 30 days from the onset of neurologic symptoms. Differences between HHV-6 encephalopathy and HSE on CT scans in the early period and in distribution and temporal changes in the affected regions on MR images in the three periods were analyzed. RESULTS. At MRI in the early and middle periods, all eight patients with HHV-6 encephalopathy had exclusive involvement of the mesial temporal lobes, and all nine patients with HSE had involvement of both the mesial temporal lobes and the extratemporal regions (p < 0.01). Among patients who underwent head MRI, six of six with HHV-6 encephalopathy but none of six with HSE had resolution of high signal intensity on T2-weighted and FLAIR images (p < 0.01). Among patients who underwent head CT in the early period, none of the four with HHV-6 encephalopathy and six of the seven with HSE had abnormal findings, including parenchymal swelling, decreased attenuation of affected regions, and abnormal gyral enhancement (p < 0.05). CONCLUSION. Serial MRI showed transient abnormal signal intensity in the mesial temporal lobes in patients with HHV-6 encephalopathy but persistent abnormal signal intensity in both the mesial temporal lobes and the extratemporal regions in patients with HSE. CT in the early period showed no abnormality in patients with HHV-6 encephalopathy but definite abnormal findings in patients with HSE. These differences may be useful in the differential diagnosis of the two conditions.

Original languageEnglish
Pages (from-to)754-760
Number of pages7
JournalAmerican Journal of Roentgenology
Volume194
Issue number3
DOIs
Publication statusPublished - Mar 1 2010

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Herpes Simplex Encephalitis
Human Herpesvirus 6
Brain Diseases
Simplexvirus
Temporal Lobe
Head
Acyclovir
Neurologic Manifestations
Differential Diagnosis
Observation

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

CT and MRI findings of human herpesvirus 6-associated encephalopathy : Comparison with findings of herpes simplex virus encephalitis. / Noguchi, Tomoyuki; Yoshiura, Takashi; Akio, Hiwatashi; Togao, Osamu; Yamashita, Koji; Nagao, Eiki; Uchino, Akira; Hasuo, Kanehiro; Atsumi, Kazushige; Matsuura, Takashi; Kuroiwa, Toshiro; Mihara, Futoshi; Honda, Hiroshi; Kudo, Sho.

In: American Journal of Roentgenology, Vol. 194, No. 3, 01.03.2010, p. 754-760.

Research output: Contribution to journalArticle

Noguchi, T, Yoshiura, T, Akio, H, Togao, O, Yamashita, K, Nagao, E, Uchino, A, Hasuo, K, Atsumi, K, Matsuura, T, Kuroiwa, T, Mihara, F, Honda, H & Kudo, S 2010, 'CT and MRI findings of human herpesvirus 6-associated encephalopathy: Comparison with findings of herpes simplex virus encephalitis', American Journal of Roentgenology, vol. 194, no. 3, pp. 754-760. https://doi.org/10.2214/AJR.09.2548
Noguchi, Tomoyuki ; Yoshiura, Takashi ; Akio, Hiwatashi ; Togao, Osamu ; Yamashita, Koji ; Nagao, Eiki ; Uchino, Akira ; Hasuo, Kanehiro ; Atsumi, Kazushige ; Matsuura, Takashi ; Kuroiwa, Toshiro ; Mihara, Futoshi ; Honda, Hiroshi ; Kudo, Sho. / CT and MRI findings of human herpesvirus 6-associated encephalopathy : Comparison with findings of herpes simplex virus encephalitis. In: American Journal of Roentgenology. 2010 ; Vol. 194, No. 3. pp. 754-760.
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abstract = "OBJECTIVE. It is important to differentiate human herpesvirus 6 (HHV-6)-associated encephalopathy from herpes simplex encephalitis (HSE). Although these conditions are similar with regard to involvement of the mesial temporal lobe, HSE is sensitive to acyclovir but HHV-6 encephalopathy is not. We compared the imaging findings of the two conditions. MATERIALS AND METHODS. We encountered eight cases of HHV-6 encephalopathy and nine cases of HSE. We divided an observation time into early, middle, and late periods defined as 0-2, 3-30, and more than 30 days from the onset of neurologic symptoms. Differences between HHV-6 encephalopathy and HSE on CT scans in the early period and in distribution and temporal changes in the affected regions on MR images in the three periods were analyzed. RESULTS. At MRI in the early and middle periods, all eight patients with HHV-6 encephalopathy had exclusive involvement of the mesial temporal lobes, and all nine patients with HSE had involvement of both the mesial temporal lobes and the extratemporal regions (p < 0.01). Among patients who underwent head MRI, six of six with HHV-6 encephalopathy but none of six with HSE had resolution of high signal intensity on T2-weighted and FLAIR images (p < 0.01). Among patients who underwent head CT in the early period, none of the four with HHV-6 encephalopathy and six of the seven with HSE had abnormal findings, including parenchymal swelling, decreased attenuation of affected regions, and abnormal gyral enhancement (p < 0.05). CONCLUSION. Serial MRI showed transient abnormal signal intensity in the mesial temporal lobes in patients with HHV-6 encephalopathy but persistent abnormal signal intensity in both the mesial temporal lobes and the extratemporal regions in patients with HSE. CT in the early period showed no abnormality in patients with HHV-6 encephalopathy but definite abnormal findings in patients with HSE. These differences may be useful in the differential diagnosis of the two conditions.",
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T1 - CT and MRI findings of human herpesvirus 6-associated encephalopathy

T2 - Comparison with findings of herpes simplex virus encephalitis

AU - Noguchi, Tomoyuki

AU - Yoshiura, Takashi

AU - Akio, Hiwatashi

AU - Togao, Osamu

AU - Yamashita, Koji

AU - Nagao, Eiki

AU - Uchino, Akira

AU - Hasuo, Kanehiro

AU - Atsumi, Kazushige

AU - Matsuura, Takashi

AU - Kuroiwa, Toshiro

AU - Mihara, Futoshi

AU - Honda, Hiroshi

AU - Kudo, Sho

PY - 2010/3/1

Y1 - 2010/3/1

N2 - OBJECTIVE. It is important to differentiate human herpesvirus 6 (HHV-6)-associated encephalopathy from herpes simplex encephalitis (HSE). Although these conditions are similar with regard to involvement of the mesial temporal lobe, HSE is sensitive to acyclovir but HHV-6 encephalopathy is not. We compared the imaging findings of the two conditions. MATERIALS AND METHODS. We encountered eight cases of HHV-6 encephalopathy and nine cases of HSE. We divided an observation time into early, middle, and late periods defined as 0-2, 3-30, and more than 30 days from the onset of neurologic symptoms. Differences between HHV-6 encephalopathy and HSE on CT scans in the early period and in distribution and temporal changes in the affected regions on MR images in the three periods were analyzed. RESULTS. At MRI in the early and middle periods, all eight patients with HHV-6 encephalopathy had exclusive involvement of the mesial temporal lobes, and all nine patients with HSE had involvement of both the mesial temporal lobes and the extratemporal regions (p < 0.01). Among patients who underwent head MRI, six of six with HHV-6 encephalopathy but none of six with HSE had resolution of high signal intensity on T2-weighted and FLAIR images (p < 0.01). Among patients who underwent head CT in the early period, none of the four with HHV-6 encephalopathy and six of the seven with HSE had abnormal findings, including parenchymal swelling, decreased attenuation of affected regions, and abnormal gyral enhancement (p < 0.05). CONCLUSION. Serial MRI showed transient abnormal signal intensity in the mesial temporal lobes in patients with HHV-6 encephalopathy but persistent abnormal signal intensity in both the mesial temporal lobes and the extratemporal regions in patients with HSE. CT in the early period showed no abnormality in patients with HHV-6 encephalopathy but definite abnormal findings in patients with HSE. These differences may be useful in the differential diagnosis of the two conditions.

AB - OBJECTIVE. It is important to differentiate human herpesvirus 6 (HHV-6)-associated encephalopathy from herpes simplex encephalitis (HSE). Although these conditions are similar with regard to involvement of the mesial temporal lobe, HSE is sensitive to acyclovir but HHV-6 encephalopathy is not. We compared the imaging findings of the two conditions. MATERIALS AND METHODS. We encountered eight cases of HHV-6 encephalopathy and nine cases of HSE. We divided an observation time into early, middle, and late periods defined as 0-2, 3-30, and more than 30 days from the onset of neurologic symptoms. Differences between HHV-6 encephalopathy and HSE on CT scans in the early period and in distribution and temporal changes in the affected regions on MR images in the three periods were analyzed. RESULTS. At MRI in the early and middle periods, all eight patients with HHV-6 encephalopathy had exclusive involvement of the mesial temporal lobes, and all nine patients with HSE had involvement of both the mesial temporal lobes and the extratemporal regions (p < 0.01). Among patients who underwent head MRI, six of six with HHV-6 encephalopathy but none of six with HSE had resolution of high signal intensity on T2-weighted and FLAIR images (p < 0.01). Among patients who underwent head CT in the early period, none of the four with HHV-6 encephalopathy and six of the seven with HSE had abnormal findings, including parenchymal swelling, decreased attenuation of affected regions, and abnormal gyral enhancement (p < 0.05). CONCLUSION. Serial MRI showed transient abnormal signal intensity in the mesial temporal lobes in patients with HHV-6 encephalopathy but persistent abnormal signal intensity in both the mesial temporal lobes and the extratemporal regions in patients with HSE. CT in the early period showed no abnormality in patients with HHV-6 encephalopathy but definite abnormal findings in patients with HSE. These differences may be useful in the differential diagnosis of the two conditions.

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