State of the Arts

Clinical and radiological study of the central nervous system involvement
in exanthema subitum

Toshiyuki Hikita 1）, Tatsuro Kaminaga 2）, Natsue Nakamoto 1,3）, Yasushi Fujii1 ）
Hideharu Tsubaki 1）, Fumiaya Kaga 1）, Kaori Amakata 1）, Kaori Ogita 1）
Hiroshi Oba 2）, Yukishige Yanagawa 1）
Department of Pediatrics 1）, Radiology 2）, Teikyo University School of Medicine
Department of Occupational Therapy 3）, Mejiro University Faculty of Health Sciences

Abstract

　　We have investigated central nervous system involvement（convulsion or disturbance of consciousness）in exanthema subitum（CNS-ES）between 1997 and 2006 in Teikyo University Hospital.
　　42 patients were diagnosed with CNS-ES（male 16, female 26）. In evaluable patients, cure with sequelae was recorded in 7/38 patients（male 2, female 5）. Forty-one of the 42 patients diagnosed with CNS-ES exhibited convulsions during the fever period, with seven of those occurrences happening during the exanthema period. Anti human herpes virus 6 IgM was examined in 14 patients, resulting in 5 positives.
　　On single Photon Emission Computed Tomography（SPECT 99mTc hexamethylprophylene amine oxime）, 15 out of 17 patients showed abnormal decreased perfusion in the frontal lobe, hemisphere and localized areas. Decreased perfusion in the frontal lobe was observed in 8 patients（male 3, female 4）, abnormal lateral perfusion was observed in 6 cases（male 0, female 6）. Computed Tomography（CT）showed atrophy or edema in 4 of the 42 patients. Nine of 24 patients’ brain Magnetic Resonance Images（MRI）showed atrophy, delayed myelination or high intensity lesions. In patient cured with sequelae, abnormal radiological findings were seen in 0/7 patients（0％）on CT, 3/6（50.0％）on MRI and 6/6（100％）on SPECT. In cured without sequelae patients, abnormal radiological findings were seen in 4/35 patients on CT, 4/18 on MRI and 9/11 on SPECT.

Keywords：Exanthema subitum, Human herpesvirus 6 (HHV-6), SPECT(single-photon emission computed tomography), Computed tomography (CT), Magnetic resonance imaging (MRI)