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Cranial computed tomography (CT) scans were performed Table 1: Different lesions identified using MRI
using a high-resolution CT scanner (GE OPTIA 660), Features CT (n=20) MRI (n=65)
and 10 mm axial sections were obtained parallel to the Abnormal 7 30
orbitomeatal plane. Magnetic resonance (Philips Achieva Thalamic 1 (1*) 28 (20*)
3.0T) imaging (MRI) of the head was performed to obtain Basal ganglia 4 (3*) 11 (8*)
0
Hippocampus
10 (6*)
3.0 T1-weighted spin-echo (repetition time [TR] = 2000 Mid-brain 0 10 (4*)
ms, echo time [TE] = 20 ms) and T2-weighted spin-echo Pons 0 1
images (TR = 1500 ms; TE = 80 ms) in the axial, coronal, Cortex 2 5 (2*)
2
0
Insult
and sagittal planes. Section thickness was 6 mm. White matter lesions 1 6 (2*)
*Number of bilateral lesions. CT: Computed tomography, MRI: Magnetic
RESULTS resonance imaging
Ninety-two patients were included in this study, Table 2: Different kinds of cells in different JE phases
Acute
Initial
including 50 males and 42 females (male:female = 1.19:1), Cell type phase % phase % Convalescence
%
and the mean age was 42.32 ± 15.47 years. All Lymphocytes 35.67 71.06 89.68
patients (100%) had fever, 53 patients (57.61%) had Monocytes 19.33 12.27 4.7
headache, 74 patients (80.43%) occurred consciousness Activated monocytes 15.67 9.51 2.82
disorder, 21 patients (22.83%) demonstrated twitching, Neutrophils 29.67 5.84 2.49
Plasma cells
0.16
1.14
0.67
34 patients (36.96%) demonstrated dystonia, and Lymphoid cells 0 0 0.12
25 patients (27.17%) demonstrated respiratory failure. Eosinophils 0 0.04 0.04
Fifty patients (54.35%) had sequelae at discharge Basophils 0 0.08 0
following treatment. JE: Japanese encephalitis
27 samples (25.71%) demonstrated high lumbar puncture
Nineteen patients received CT examination of head pressure and 61 samples (58.10%) demonstrated
between 2 and 25 days after onset, which were normal lumbar puncture pressure, 3 samples weren’t
abnormal in 7 patients (36.84%). Abnormalities tested for pressure. The mean number of white cells
included 1 patient (5.26%) with thalamic hypodensity in CSF was (42.50 ± 71.31) × 10 /L, and 81.19% of
6
accompanied by basal ganglia and temporal lobe samples demonstrated an increase in their white cell
hypodensity, 4 patients (21.05%) with basal ganglia count. Mean chloride, glucose, and protein values
hypodensity, 2 patients (10.53%) with brain swelling, were 122.26 ± 9.02 mmol/L, 3.77 ± 1.79 mmol/L,
and 1 patient (5.26%) with frontal lobe hypodensity. 0.64 ± 0.28 g/L, respectively. In total, 67.65% and 83.33%
of samples demonstrated normal chloride and glucose
Sixty-five patients received MRI of head within 2–32 days samples (normal chloride content: 120–130 mmol/L;
after onset. Lesions appeared hyperintense on fluid normal glucose content: 2.5–4.4 mmol/L), while 82.52%
attenuated inversion recovery (FLAIR) and T2-weighted of samples demonstrated >0.4 g/L protein content. The
images, and isointense to slightly hypointense on cytological examination of CSF confirmed mixed-cell
T1-weighted images. MRI showed no lesions in reaction in 11 (10.19%) samples, an increase in activated
16 patients (24.62%) within 2–22 days after onset. MRI monocytes in 40 (37.04%) samples (lymphocytes
findings of 30 patients with clear inflammatory focus were the main cells in 35 (32.41%) samples), mainly
included varying degrees of thalamic lesions except lymphocyte reaction in 41 (37.96%) samples (neutrophil
two patients. MRI lesions were also noted in the basal were found in 15), typical lymphocyte reaction in
ganglia in 11 patients, mid-brain and hippocampus in 12 (11.11%) samples, and <100 cells in 4 (3.7%)
10 patients, pons in 1 patient, and cerebral cortex in samples. We also analyzed the proportion of various
5 patients [Table 1]. cells in different JE phases [Table 2].

Seventy-five patients underwent lumbar puncture, DISCUSSION
and 34 patients required puncture more than once.
Symptom duration prior to lumbar puncture ranged The imaging findings obtained using CT and MRI
between 3 and 33 days after onset. Hence, we identified showed the pathological changes that occur in JE
108 CSF samples (3 in the initial phase, 53 in the acute patients. JE patients typically demonstrate hypodense
phase and 52 in convalescence). The mean lumbar lesions in the thalamus and basal ganglia on CT. MRI
puncture pressure was 173.41 ± 77.87 mmH O, and is more sensitive than CT for revealing abnormalities,
[8]
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30 Neuroimmunol Neuroinflammation | Volume 1 | Issue 1 | June 2014