Neuroimaging and neurological outcome of children with acute encephalitis

Abstract

Aim: To investigate the severity of acute phase magnetic resonance imaging (MRI) findings and severity of acute illness as risk factors for disability after recovery from encephalitis. Method: Children with encephalitis (n = 98; median age 6 years 10 months, interquartile range 3 years–11 years 6 months; 59 males, 39 females) treated in Turku University Hospital during the years 1995 to 2016 were identified in this retrospective cohort study. The acute phase (<2 months of symptom onset) brain MRIs were re-evaluated and classified based on the severity of neuroimaging finding by a neuroradiologist. Neurological outcome at discharge, at short-term (<3 months from discharge) follow-up, and at long-term (>1 year from discharge) follow-up was assessed from medical records using the Glasgow Outcome Scale. Results: Long-term recovery was poor in 24 of 82 (29%) children with follow-up data. Two children died, eight had severe disability, and 14 had moderate disability. Acute phase MRI was available for re-evaluation from 74 of 82 patients with follow-up data. The increasing severity of MRI findings was associated with need for ventilator therapy and with poor recovery. Interpretation: The risk for poor recovery in paediatric encephalitis is high, and it is associated with the severity of MRI findings. What this paper adds: Poor long-term recovery was found in 29% of children with encephalitis. Severe disability measured by Glasgow Outcome Scale was found in 8%. The most severe neuroimaging findings were a risk factor for severe acute illness and poor long-term recovery.