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Nipah Virus Encephalitis: Serial MR Study of an Emerging Disease¹

¹ From the Departments of Neuroradiology (C.C.T.L., Y.Y.S., F.H.) and Neurology (K.E.L., W.L.L.), National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; Department of Medicine, National University Hospital, Singapore (P.A.T.); Department of Infectious Disease, Tan Tock Seng Hospital, Singapore (C.C.L.); Department of Neurology, Singapore General Hospital (A.P.A.); and Department of Radiology, Changi General Hospital, Singapore (B.K.M.L.). From the 2000 RSNA scientific assembly. Received February 21, 2001; revision requested April 9; revision received May 16; accepted June 20. Supported in part by National Medical Research Council grant NMRC/NRN99/005. Address correspondence to C.C.T.L. (e-mail: tchoyoson_lim@notes.ttsh.gov.sg).

PURPOSE: To report the serial magnetic resonance (MR) imaging findings of the Nipah virus.

MATERIALS AND METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.

Index terms: Brain, MR, 13.121411, 13.121412, 13.121413, 13.121415, 13.141416, 13.12143, 13.12144, 13.12145 • Encephalitis, 13.253

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