Abstract
Chikungunya fever is an arbovirus infection transmitted by the same mosquito vector of dengue and Zika virus. Besides high fever, common clinical symptoms include articular pain and general malaise. Neurological involvement is unusual, but some patients may develop peripheral and central nervous system involvement, including meningoencephalitis, myelitis, Guillain-Barré syndrome, and acute disseminated encephalomyelitis. We present three cases of Chikungunya fever complicated with extensive myelitis. The spinal cord magnetic resonance imaging (MRI) pattern is characterized by multiple dotted-like and longitudinal hyperintense lesions, with contrast enhancement, mostly distributed in the peripheral regions of the spinal cord. It seems that these lesions are mostly located in the perivascular spaces (PVS), related or not to virus attack. Involvement of brain PVS can also be demonstrated, as shown in two of the cases described. Considering the MRI pattern, extensive spinal cord lesion should include Chikungunya as a differential diagnosis, especially during an outbreak.
This is a preview of subscription content, log in via an institution to check access.
References
Acosta-Ampudia Y, Monsalve DM, Castillo-Medina LF (2018) Autoimmune neurological conditions associated with Zika virus infection. 11
Bank AM, Batra A, Colorado RA, Lyons JL (2016) Myeloradiculopathy associated with chikungunya virus infection. J Neurovirol 22:125–128
Cerny T, Schwarz M, Schwarz U, Lemant J, Gérardin P, Keller E (2017) The range of neurological complications in chikungunya fever. Neurocrit Care 27(3):447–457
Chandak NH, Kashyap RS, Kabra D et al (2009) Neurological complications of Chikungunya virus infection. Neurol India Mar-Apr;57(2):177–80
Chen C, Liu C, Fang L et al (2019) Different magnetic resonance imaging features between MOG antibody and AQP4 antibody-mediated disease: a Chinese cohort study. J NeurolSci 15(405):116430
Choudhary N, Makhija P, Puri V, Khwaja GA, Duggal A (2016) An unusual case of myelitis with myositis. J Clin Diagn Res May;10(5):OD19–20
Correa DG, Freddi Tal, Werner H et al (2020) Brain MR imaging of patients with perinatal Chikungunya virus infection. AJNR Am J Neuroradiol Jan 41(1):74–177
Couderc T, Chretien F, Schilte C et al (2008) A mouse model for Chikungunya: young age and inefficient type-I interferon signaling and risk factors for severe disease. PLoS Pathog 4(2):e29
De Brito CAA (2017) Alert: Severe cases and deaths associated with Chikungunya in Brazil. Rev Soc Bras Med Trop 50(5):585–589
De Sousa AM, Alvarenga MP, Alvarenga RMP (2014) A cluster of transverse myelitis following dengue virus infection in the Brazilian Amazon region. Trop Med Health 42(3):115–120
Economopoulou A, Domingues M, Helynck B et al (2009) Atypical Chikungunya virus infections: clinical manifestations, mortality and risk factors for severe disease during the 2005–2006 outbreak on Reunion. Epidemiol Infect 137:534–541
Ganesan K, Diwan A, Shankar SK, Desai SB, Sainani GS, Katrak SM (2008) Chikungunya encephalomyeloradiculitis: report of 2 cases with neuroimaging and 1 case with autopsy findings. Am J Neuroradiol 29:1636–1637
Hygino da Cruz LC, Jr, (2018) Nascimento OJM, Lopes FPPL and da Silva IRF. Neuroimaging findings of Zika virus-associated neurologic complications in adults. AJNR Am J Neuroradiol 39(11):1967–1974
Khatri H, Shah H, Roy D, Tripathi KM (2018) A case report on Chikungunya virus-associated encephalomyelitis. Case Rep Infect Dis 10:8904753
Lam MA, Hemley SJ, Najafi E, Vella NGF, Bilston LE, Stoodley MA (2017) The ultrastructure of spinal cord perivascular spaces: implications for the circulation of cerebrospinal fluid. Sci Rep 7(1):12924
Liu S, Lam MA, Sial A, Hemley SJ, Bilston LE, Stoodley MA (2018) Fluid outflow in the rat spinal cord: the role of perivascular and paravascular pathways. Fluid Barriers CNS 15:13
Mehta R, Gerardin P, de Brito CAA, Soares CN, Ferreira MLB, Solomon T (2018) The neurological complications of chikungunya virus: a systematic review. Rev Med Virol 28(3):e1978
Mehta R, Soares CN (2018) Medialdea-Carrera et al The spectrum of neurological disease associated with Zika and chikungunya viruses in adults in Rio de Janeiro, Brazil: a case series. PLoSNegl Trop Dis 12(2):e0006212
Pereira LP, Villas-Boas R (2017) Scott SSO et al Encephalitis associated with the chikungunya epidemic outbreak in Brazil report of 2 cases with neuroimaging findings. Rev Soc Bras Med Trop 50(3):4163–4416
Plog BA, Nedergaard M (2018) The glymphatic system in CNS health and disease: past, present and future. Annu Rev Pathol 13:379–394
Qu F, Qu Z, Lv Y, Song B, Wu B (2020) Disseminated cryptococcosis revealed by transverse myelitis in immunocompetent patient: a case report and review of the literature. BC Neurology 20:13
Rudie J, Rauschecker AM, Nabavizadeh SA, Mohan S (2018) Neuroimaging of dilated perivascular spaces: from benign and pathologic causes to mimics. J Neuroimaging 28(2):139–149
Sarbu N, Lolli V, Smirniotopoulos JG (2019) Magnetic resonance imaging in myelopathy: a pictorial review. Clin Imaging Sep-Oct;57:56–68
Secretaria de VigilânciaemSaúde/Ministério da Saúde (2019) Monitoramento dos casos de arboviroses urbanas transmitidas pelo Aedes (dengue, Chikungunya e Zika) até a semana epidemiológica 30 de 2019 e levantamento rápido de índices para Aedes aegypti (LIRAa). Boletimepidemiológico 30:1–13
Shakudo M, Inoue Y, Tsuyoshi T (1999) HTLV-1 associated myelopathy: acute progression and atypical MR findings. AJNR Am J Neuroradiol 20:1417–1421
Siripaitoon P, Hirunpat S, Silpapojakul K (2011) Short report: case reports of neuro-Chikungunya in southern Thailand. An J Trop Med Hyg 85(2):386–389
Teixeira AAR, Ferreira LF, Neto RJP (2019) Acute disseminated encephalomyelitis after chikungunya infection. JAMA Neurolo Mar 4. 10.1001
Tomczak A, Su E, Tugizova M et al (2019) A case of GFAP-astroglial autoimmunity presenting with reversible parkinsonism. Mult Scler Relat Disord Dec19;39:101900
Trebst C, Raab P, Voss EV et al (2011) Longitudinal extensive transverse myelitis-it’s not all neuromyelitis optica. Nat Rev Neurol Nov1;7(12):688–98
Wu Y, Wu W (2020) Neurosyphilis presenting with myelitis-case series and literature review. J Infect Chemother 26(2):296–299
Yokota H, Yamada K (2015) Viral infection of the spinal cord and roots. NeuroimagClin N Am 25:247–258
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Rueda-Lopes, F.C., da Cruz, L.C.H., Fontes, F.L. et al. Clinical and magnetic resonance imaging patterns of extensive Chikungunya virus–associated myelitis. J. Neurovirol. 27, 616–625 (2021). https://doi.org/10.1007/s13365-021-00962-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13365-021-00962-4