ECHO 25 focal encephalitis and subacute hemichorea

Abstract

Echovirus 25 focal encephalitis was documented for the 1st time in a 5 yr old boy with unequivocal hemichorea. Hemichorea caused by enterovirus CNS diseas was never reported. Echovirus antigen in CSF cells was demonstrated by the indirect immunofluorescent technique and typed by a significant rise in neutralizing antibodies against echovirus 25. Sequential computerized tomographic (CT) studies with digital analysis demonstrated the evolution of a focal process in the head of the left caudate nucleus, ultimately leading to replacement of tissue by a CSF-containing cyst. In the unclarified pathogenesis of cerebral disease in enterovirus infection, this case suggests a focal inflammatory process rather than vasculitis, occlusion and infarction. The near-complete recovery of the patient demonstrated that the mere loss of neostriatal tissue was not decisive in itself, because the tissue loss was permanent and the symptoms were transient.