Starry Sky on MRI brain: Unusually observed in a pediatric case of Japanese Encephalitis
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Abstract
A 13-year-old girl presented with fever, nausea and projectile vomiting and altered sensorium. On physical examination, the meningeal signs were presented without focal neurological deficits and Grade Ⅱ papilledema was presented on fundus examination. The patient was found to be positive for Japanese encephalitis virus in cerebrospinal fluid. Focal neurological deficit in the form of right hemiparesis was noticed at day 6 of hospitalisation. Multiple lesions with minimal enhancement with perilesional edema were observed in cerebral cortex in contrast with enhanced magnetic resonance imaging of the brain, giving rise to starry sky appearance. No tests for neurotuberculosis were found positive. Serum IgG enzyme-linked immunosorbent assay test was negative for Cysticercosis, but magnetic resonance spectroscopy was suggestive of cysticercal meningitis. During treatment, she had intermittent episodes of nausea and vomiting with waxing and waning sensorium. Subsequently, it was planned to start Albendazole after steroids coverage and anticonvulsants but the patient did not improve and succumbed to her illness.
[2] Kalita J, Misra UK. Comparison of CT scan and MRI findings in the diagnosis of Japanese encephalitis. J Neurol Sci 2000;174:3- 8. https://doi.org/10.1016/S0022-510X(99)00318-4.
[3] Mahajan RC. Geographical distribution of human cysticercosis. In Cysticercosis: Present state of Knowledge and Perspectives, (Ed.) Ana Flisser, et al. Academic Press 1982, 39- 46.
[4] Singhi P, Singhi S. Neurocysticercosis in children. Indian J Pediatr. 2009;76:537–545. https://doi.org/10.1007/s12098- 009-0139-5.
[5] Kalra V, Mittal R, Rana KS, Gupta A. Neurocysticercosis: Indian experience. Perat MV (Ed), New Developments in Hawaii. Neurology, Monduzzi Editore S.P.A. Bologna, Italy; 1998 pp 353-359.
[6] Sengupta SN, Sen MK, Das PK, et al. Clinical profile of epidemic of Japanese encephalitis. Indian J Med Res1976;54:1393–402. PMID: 190166.
[7] Abe TK, Kojima K, Shoji N, et al. Japanese encephalitis. J Magn Reson Imaging 1998;8:755–61. https://doi.org/10.1002/ jmri.1880080402.
[8] Garcia HH, Gonzalez AE, Gilman RH. Cysticercosis of the central nervous system— how should it be managed? Curr Opin Infect Dis 2011;24:423–7. https://doi.org/10.1097/ QCO.0b013e32834a1b20.
[9] Singhi P. Neurocysticercosis. Ther Adv Neurol Disord 2011;4:67– 81. https://doi.org/10.1177/1756285610395654
[10] GarciaHH,NashTE,BruttoOHD.Clinicalsymptoms,diagnosis,and treatment of neurocysticercosis. Lancet Neurol 2014;13:1202– 15. https://doi.org/10.1177/1756285610395654.
[11] Singh P, Kalra N, Ratho RK, et al. Co-existent neurocysticercosis and Japanese B encephalitis: MR imaging co-relation. AJNR Am J Neuroradiol. 2001;22(6):1131-6. PMID: 11415909.
[12] Azad R, Gupta RK, Kumar S, et al. Is neurocysticercosis a risk factor in coexistent intracranial disease? An MRI based study. J Neurol Neurosurg Psychiatry 2003;74:359–6. https://doi. org/10.1136/jnnp.74.3.359.
[13] Desai A, Shankar SK, Jayakumar PN, et al. Co-existence of cerebral cysticercosis with Japanese encephalitis: a prognostic modulator. Epidemiol Infect 1997;118:165–71. https://doi. org/10.1017/S0950268896007327.
[14] Shankar SK, Vasudev Rao T, Mruthyunjayanna BP, Gourie Devi M, Deshpande D H. Autopsy study of brains during an epidemic of Japanese encephalitis in Karnataka. Ind J Med Res 1983;78:431–40. PMID: 6325338.
[15] Kalita J, Misra UK, Pandey S, et al. A comparision of clinical and radiological findings in adults and children with Japanese encephalitis. Arch Neurol 2003;60:1760–64. https://doi. org/10.1001/archneur.60.12.1760.
| Files | ||
| Issue | Vol 7 No 3 (2022): May-June | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/crcp.v7i3.11128 | |
| Keywords | ||
| Japanese encephalitis Starry sky Pediatric Acute encephalitis syndrome | ||
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