"Clock dial pattern", a radiologic clue to neuro-chikungunya diagnosis: a case series

Fraiman, Pedro Henrique Almeida; Freire, Mariana; Fernandes, Bruno; Palitot, Felipe; Mota, Nathalia; Sequerra, Eduardo; Santos, Glauco; Dourado, Mario Emilio; Godeiro-Junior, Clecio de Oliveira; Moreira-Neto, Manuel

doi:10.1055/s-0044-1779033

Acessibilidade / Reportar erro

Brasil

Arquivos de Neuro-Psiquiatria

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Arq. Neuro-Psiquiatr. 82 (1) • 2024 • https://doi.org/10.1055/s-0044-1779033 copy

"Clock dial pattern", a radiologic clue to neuro-chikungunya diagnosis: a case series

"Padrão em ponteiro de relógio", uma dica radiológica para o diagnóstico de neurochikungunya: série de casos

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Chikungunya is a mosquito-borne disease caused by the chikungunya virus (CHIKV) and can lead to neurological complications in severe cases.

Objective

This study examined neuroimaging patterns in chikungunya cases during two outbreaks in Brazil to identify specific patterns for diagnosis and treatment of neuro-chikungunya.

Methods

Eight patients with confirmed chikungunya and neurological involvement were included. Clinical examinations and MRI scans were performed, and findings were analyzed by neuroradiologists. Data on age, sex, neurological symptoms, diagnostic tests, MRI findings, and clinical outcomes were recorded.

Results

Patients showed different neuroimaging patterns. Six patients exhibited a "clock dial pattern" with hyperintense dotted lesions in the spinal cord periphery. One patient had thickening and enhancement of anterior nerve roots. Brain MRI revealed multiple hyperintense lesions in the white matter, particularly in the medulla oblongata, in six patients. One patient had a normal brain MRI.

Conclusion

The "clock dial pattern" observed in spinal cord MRI may be indicative of chikungunya-related nervous system lesions. Isolated involvement of spinal cord white matter in chikungunya can help differentiate it from other viral infections. Additionally, distinct brainstem involvement in chikungunya-associated encephalitis, particularly in the rostral region, sets it apart from other arboviral infections. Recognizing these neuroimaging patterns can contribute to early diagnosis and appropriate management of neuro-chikungunya.

Keywords
Chikungunya Virus; Myelitis; Arbovirus Infections

Patient	Age	Sex	Year of occurrence	Neurological presentation	Discharge clinical outcome	Diagnostic test	Time from beginning of symptoms (weeks)	Spinal cord MRI	Brainstem MRI	Brain MRI
1	36	Female	2016	Acute respiratory failure, flaccid and areflexic tetraparesis, seizures, Babinski sign, and bladder disfunction	Sensory deficit and neuropathic pain.	IgM + , serum	4	T2 hyperintense small dotted lesions, mainly on the periphery of the spinal cord	T2 hyperintense lesions in the medulla	T2 hyperintense lesions in deep white matter; no restricted diffusion on DWI
2	75	Female	2016	Lower limbs pain, acute respiratory failure, difficulty walking, and bladder disfunction	Axonal lumbosacral polyradiculoneuropathy	IgM + , serum	4	T2 hyperintense small dotted lesions, mainly on the periphery of the spinal cord	Absence of findings	T2 hyperintense lesions in white matter mainly in the periventricular region, non-specific, may correspond to microangiopathy
3	70	Female	2016	Acute flaccid paraplegia, urinary retention, and constipation	Hypoesthesia under T8 level	IgM + , serum	2	T2 hyperintense and Gd-enhancing small dotted lesions, mainly on the periphery of the spinal cord (cervical and thoracic spine).	Discrete T2 hyperintense focal lesions	Absence of findings
4	49	Male	2016	Lumbar pain and flaccid areflexic asymmetric paraparesis and bladder disfunction	Neurogenic bladder	RT-PCR, serum	4	Thickening and enhancement of the anterior nerve roots of the cauda equina	No data available	No data available
5	58	Male	2019	Superficial and deep hypoesthesia with a sensitive level in T10	Clinical recovery	IgM + , serum	4	T2 hyperintense small dotted lesions in multiple segments, mainly on the periphery of the spinal cord	No data available	No data available
6	75	Female	2016	Quadriparesis (lower extremity predominance), acute flaccid paraparesis, thoracic sensory level, bladder disfunction	Clinical recovery	IgM + , serum	4	Absence of findings	T2 hyperintense dotted lesions, mainly on the anterior region of the medulla	Multifocal hyperintense T2 lesions spread through the cerebral white matter
7	60	Male	2019	Acute respiratory failure, paresis of the lower extremity and, bladder disfunction	Encephalomyeloradiculitis	IgM + , serum	6	T2 hyperintense small dotted lesions in multiple segments, mainly on the periphery of the spinal cord	T2 hyperintense small lesions in the anterior medulla. No enhancement detected	Small multifocal T2 hyperintense lesions spread in cerebral white matter with the confluence in the sublenticular region, no enhancement detected, and with restricted diffusion on DWI.
8	58	Male	2019	Bladder dysfunction, constipation, flaccid quadriparesis	Clinical improvement with corticosteroids pulse therapy	RT-PCR, serum	1	T2 hyperintense small dotted lesions in multiple segments, mainly on the periphery of the spinal cord	Absence of findings	Absence of findings

Academia Brasileira de Neurologia - ABNEURO R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices Torre Norte, 04101-000 São Paulo SP Brazil, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revista.arquivos@abneuro.org

Acompanhe os números deste periódico no seu leitor de RSS

[1] Address for correspondence Clecio Godeiro-Junior (email: clecio.godeiro@ufrn.br)