Severity-Related Structural MRI Changes in Children with Viral Panencephalitis

Abstract

Viral panencephalitis in children is associated with heterogeneous clinical manifestations and variable patterns of structural brain involvement. Standard magnetic resonance imaging plays a central role in the evaluation of inflammatory lesions of the central nervous system; however, the relationship between MRI findings and clinical severity of pediatric viral panencephalitis remains insufficiently systematized. To evaluate structural magnetic resonance imaging changes in children with viral panencephalitis and to determine their relationship with the clinical severity of central nervous system involvement. This retrospective study included 122 pediatric patients with viral panencephalitis divided into three groups according to clinical severity of neurological involvement. Group I included 41 children with relatively favorable disease course, Group II included 43 patients with moderate neurological impairment, and Group III consisted of 38 children with severe central nervous system involvement. All patients underwent standard brain magnetic resonance imaging. Structural MRI patterns, anatomical distribution of lesions, edema-dislocation changes, and chronic structural sequelae were analyzed comparatively between the study groups. MRI findings demonstrated progressive transition from focal and limited brain lesions in Group I toward multifocal and diffuse structural involvement in children with more severe clinical manifestations. Diffuse brain abnormalities were identified in 73.7% of patients from Group III compared with 7.3% in Group I. Severe forms of viral panencephalitis were associated with extensive involvement of subcortical and deep white matter structures, basal ganglia, brainstem, and cerebellum. Pronounced cerebral edema, mass effect, and midline shift became progressively more frequent with increasing disease severity. Chronic MRI sequelae, including gliosis, cerebral atrophy, enlargement of cerebrospinal fluid spaces, and ventriculomegaly, were predominantly observed in children with severe forms of panencephalitis. Structural MRI demonstrates a clear association between the extent of brain involvement and the clinical severity of viral panencephalitis in children. Diffuse white matter injury, deep structure involvement, and edema-dislocation changes may serve as important radiological markers of severe central nervous system injury and unfavorable disease course.