Case Report
Very Rarely Reported MRI Brain Changes - Spectrum of MRI Brain Changes in Serological Proven Case of Scrub Typhus Encephalopathy for Early Diagnosis
Sudhir S*, Kshipra K and Aravindh R
Department of Radiodiagnosis, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Puducherry, Puducherry Union Territory, India
*Corresponding author: Sudhir Sachar, Department of Radiodiagnosis, Mahatma Gandhi Medical College and Research Institute, Puducherry. Email Id: sudhirsachar@gmail.com
Article Information: Submission: 24/08/2023; Accepted: 26/09/2023; Published: 29/09/2023
Copyright: © 2023 Sudhir S, et al. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Introduction: Scrub typhus or bush typhus caused by Orientia tsutsugamushi is a common, zoonotic disease in South East Asia. Although CNS involvement in scrub typhus is well described but there are extremely rare documented studies of Brain changes in MRI in this infection. This is a case report of scrub typhus induced encephalopathy showing changes in Brain on MRI. The spectrum of MRI brain changes being reported by us is very important for scientific/medical community for correct early diagnosis and management, to save lives.
Methodology: Observational type of case study using 1.5 Tesla MRI. 45 years male presented with history of occipital headache for 5 days, projectile non-bilious vomiting and giddiness multiple episodes of upward rolling of eyes with loss of consciousness for few seconds and involuntary micturition. No known comorbidities. Patient is non-alcoholic, non-smoker, farmer by profession. Widal test was negative. Malaria and Dengue rapid card test - negative. Scrub typhus rapid card test - Positive for IgM antibodies (Inbios, USA). Spectrum of Brain changes on MRI: T2 and FLAIR images showed hyperintensity in head of bilateral caudate nuclei and in bilateral lentiform nuclei (more so in putamen). Also noted were mild bilateral hyperintensities in thalami on T2 and FLAIR (more evident on FLAIR). Lesions showed no restricted diffusion on DWI.
Conclusion: Based on the patient’s clinical and radiological characteristics, “Scrub Typhus Induced Encephalopathy” was diagnosed & it was confirmed serologically.
Methodology: Observational type of case study using 1.5 Tesla MRI. 45 years male presented with history of occipital headache for 5 days, projectile non-bilious vomiting and giddiness multiple episodes of upward rolling of eyes with loss of consciousness for few seconds and involuntary micturition. No known comorbidities. Patient is non-alcoholic, non-smoker, farmer by profession. Widal test was negative. Malaria and Dengue rapid card test - negative. Scrub typhus rapid card test - Positive for IgM antibodies (Inbios, USA). Spectrum of Brain changes on MRI: T2 and FLAIR images showed hyperintensity in head of bilateral caudate nuclei and in bilateral lentiform nuclei (more so in putamen). Also noted were mild bilateral hyperintensities in thalami on T2 and FLAIR (more evident on FLAIR). Lesions showed no restricted diffusion on DWI.
Conclusion: Based on the patient’s clinical and radiological characteristics, “Scrub Typhus Induced Encephalopathy” was diagnosed & it was confirmed serologically.
Keywords: Scrub Typhus Induced Encephalopathy; Mri,Thalami; Caudate Nuclei; Putamen.