Nipah Virus Encephalitis: Serial MR Study of an Emerging Disease1

Department of Neuroradiology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
Radiology (Impact Factor: 6.87). 02/2002; 222(1):219-26. DOI: 10.1148/radiol.2221010499
Source: PubMed


To report the serial magnetic resonance (MR) imaging findings of the Nipah virus.
Twelve patients underwent serial MR imaging. Eight patients were examined at the outbreak; 11, at 1 month; and seven, at 6 months. Contrast material-enhanced MR images, diffusion-weighted images, and single-voxel proton MR spectroscopic images were reviewed. Clinical and neurologic assessment, as well as analysis of the size, location, and appearance of brain lesions on MR images, were performed.
During the outbreak, all eight patients had multiple small foci of high signal intensity within the white matter on T2-weighted images. In six patients, cortical and brain stem lesions were also detected, and five patients had diffusion-weighted MR imaging-depicted hyperintensities. One month after the outbreak, five patients had widespread tiny foci of high signal intensity on T1-weighted images, particularly in the cerebral cortex. Diffusion-weighted images showed decreased prominence or disappearance of lesions over time. There was no evidence of progression or relapse of the lesions at 6-month follow-up. MR spectroscopy depicted reduction in N-acetylaspartate-to-creatine ratio and elevation of choline-to-creatine ratios.
The Nipah virus has findings unlike other viral encephalitides: small lesions that are primarily within the white matter, with transient punctate cortical hyperintensities on T1-weighted images.

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    • "A pulmonary syndrome has been described in some patients who present with cough, atypical pneumonia, and abnormal chest X-Ray findings [49–51]. Brain MR scans in acute henipavirus encephalitis show typical, disseminated, small discrete hyperintense lesions in both grey and white matter [23, 52, 53]. "
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    ABSTRACT: Zoonoses as causes of human infections have been increasingly reported, and many of these are viruses that cause central nervous system infections. This paper focuses on the henipaviruses (family Paramyxoviridae, genus henipavirus) that have recently emerged to cause severe encephalitis and systemic infection in humans and animals in the Asia-Pacific region. The pathological features in the human infections comprise vasculopathy (vasculitis, endothelial multinucleated syncytia, thrombosis, etc.) and parenchymal cell infection in the central nervous system, lung, kidney, and other major organs. Most animals naturally or experimentally infected show more or less similar features confirming the dual pathogenetic mechanism of vasculopathy-associated microinfarction and direct extravascular parenchymal cell infection as causes of tissue injury. The most promising animal models include the hamster, ferret, squirrel monkey, and African green monkey. With increasing evidence of infection in the natural hosts, the pteropid bats and, hence, probable future outbreaks in many more countries, a greater awareness of henipavirus infection in both humans and animals is imperative.
    Full-text · Article · Sep 2011 · Pathology Research International
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    • "Computed tomography of the head is normal, but MRI findings on T1- weighted imaging include multiple widespread small lesions in the white matter, mostly in the frontal and parietal lobes (Lee et al., 1999; Goh et al., 2000). The pons and cerebellum have also been affected (Lim et al., 2002). T2-weighted imaging demonstrates hyperintense lesions in gray matter and on fluid-attenuated inversion recovery sequences. "
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    ABSTRACT: Nipah and Hendra viruses are two zoonotic paramyxoviruses with an ability to cause fatal encephalitic and respiratory diseases in humans. Nipah and Hendra viruses are negative sense, single-stranded RNA viruses in the Paramyxoviridae family, subfamily Paramyxovirinae. They are categorized in the recently named genus Henipavirus, one of five genera in the subfamily (the others are Respirovirus, Morbillovirus, Avulavirus, and Rubulavirus). Other human pathogenic viruses exist in these other genera, such as measles, mumps, and parainfluenza viruses; Nipah and Hendra viruses, in the genus Henipavirus, and Menangle virus, in the genus Rubalavirus, are unique in that they are zoonotic and are viruses that have recently emerged in humans. A similarity exists between the epidemiology of each of these two viruses, such as the Pteropus fruit bat as the natural host for both viruses. For both Hendra and Nipah viruses, it is presumed that horses and pigs that have acted as an intermediary host to humans had been infected by indirect contact with pteropid bats endemic in these regions, although this has not been experimentally proven.
    Preview · Article · Dec 2006 · Perspectives in Medical Virology
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    • "The spinal fluid was striking with cell counts up to 1000 and protein contents up to 400 mg % (Goh et al, 2000; Li et al, 1999). The most characteristic finding, however, was the magnetic resonance imaging that showed multiple, small (less the 2 cm), high signal densities within the white matter on T-2 weighted images (Lim et al, 2002). About one third of patients had an ingravescent course to death. "
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    ABSTRACT: New viral infections of the nervous system have been appearing with great regularity. Some result from the evolution of new agents and others from the entry of viruses into new hosts or environments. The emergence of neurovirulent enteroviruses causing a paralytic poliomyelitis syndrome and rhomboencephalitis represent the evolution of new human viruses. Most emerging viral infections represent movement of an agent into new geographic areas or across species barriers. The transport of neurovirulent strains of West Nile virus into the Western Hemisphere and the penetration of Nipah virus, a newly recognized paramyxovirus, across species barriers from bat to pig to man are examples that are highlighted in this review. The burgeoning human population and the speed and frequency of travel favor the evolution, preservation, and spread of new viral agents.
    Preview · Article · May 2003 · Journal of NeuroVirology
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