“Clock dial pattern”, a radiologic clue to neuro-chikungunya diagnosis: a case series

Author:

Fraiman Pedro Henrique Almeida12ORCID,Freire Mariana3ORCID,Fernandes Bruno1ORCID,Palitot Felipe3ORCID,Mota Nathalia3ORCID,Sequerra Eduardo4ORCID,Santos Glauco5ORCID,Dourado Mario Emilio1ORCID,Godeiro-Junior Clecio de Oliveira1ORCID,Moreira-Neto Manuel3ORCID

Affiliation:

1. Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Divisão de Neurologia, Natal RN, Brazil.

2. Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.

3. Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Divisão de Radiologia, Natal RN, Brazil.

4. Universidade Federal do Rio Grande do Norte, Instituto do Cérebro, Natal RN, Brazil.

5. Hospital Giselda Trigueiro, Divisão de Infectologia, Natal RN, Brazil.

Abstract

Abstract Background Chikungunya is a mosquito-borne disease caused by the chikungunya virus (CHIKV) and can lead to neurological complications in severe cases. Objective This study examined neuroimaging patterns in chikungunya cases during two outbreaks in Brazil to identify specific patterns for diagnosis and treatment of neuro-chikungunya. Methods Eight patients with confirmed chikungunya and neurological involvement were included. Clinical examinations and MRI scans were performed, and findings were analyzed by neuroradiologists. Data on age, sex, neurological symptoms, diagnostic tests, MRI findings, and clinical outcomes were recorded. Results Patients showed different neuroimaging patterns. Six patients exhibited a “clock dial pattern” with hyperintense dotted lesions in the spinal cord periphery. One patient had thickening and enhancement of anterior nerve roots. Brain MRI revealed multiple hyperintense lesions in the white matter, particularly in the medulla oblongata, in six patients. One patient had a normal brain MRI. Conclusion The “clock dial pattern” observed in spinal cord MRI may be indicative of chikungunya-related nervous system lesions. Isolated involvement of spinal cord white matter in chikungunya can help differentiate it from other viral infections. Additionally, distinct brainstem involvement in chikungunya-associated encephalitis, particularly in the rostral region, sets it apart from other arboviral infections. Recognizing these neuroimaging patterns can contribute to early diagnosis and appropriate management of neuro-chikungunya.

Publisher

Georg Thieme Verlag KG

Subject

Neurology,Neurology (clinical)

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