Sanne Hoeks

Restrained inflammation and neonatal WMI in viral encephalitis 65 5 matter lesions in the frontal and parietal lobe whereas in three infants with HSV distribution of white matter lesions was asymmetrical and present in the parietal and temporal lobes, in the deep grey matter and optic radiation (Fig 1). FIGURE 1. MRI, axial plane in an infant with EV (A), HPeV (B) and HSV (C) infection. In A, a T2 sequence is used, in B and C, DWI. The distribution of abnormalities in the white matter is comparable. In the infant with EV infection there is a hemorrhagic component. In the infants with HPeV and HSV infection, involvement of the corpus callosum and optic radiation (left side) is seen as well and in the infant with HPeV infection the internal capsule shows also restricted diffusion. Neurodevelopmental outcome Infants with EV and HPeV encephalitis were noted to have better cognitive and motor scores at follow up visits compared to infants with HSV encephalitis. Six of eight infants with EV encephalitis had a favorable clinical outcome at a median follow-up of 60 (range 3-96) months. Follow-up was discontinued during the first year in three infants without clinical seizures and without MRI abnormalities. One infant died due to redirection of care because of severe, extensive cerebral damage seen on MRI. Following HPeV encephalitis, one infant had mild behavioral problems and in the other four infants a normal outcome was observed at a median age of 60 (range 2-60) months. None of the infants with EV and HPeV developed epilepsy and the GMDS assessment scores were within the normal range with a median developmental quotient (DQ) of 105 (range 97-109). One of the four infants with HSV died, two developed epilepsy and showed neurodevelopmental delay. One of these infants scored within the normal range on the GMDS with DQ 89 at 24 months but with a speech and language disorder and 93 on the WPPSI at 6 years of age. The other child scored within the normal range on GMDS with DQ 98 at 42 months but the WPPSI-II showed a total IQ of 80 at 6 years of age. One infant with HSV developed hypsarrythmia and cerebral palsy and was too severely affected to be formally assessed.