- Serviço de Neurorradiologia, Hospital Dona Estefânia, CHULC
- XV Congresso Nacional da SPNR, 28-29 Junho 2019, Coimbra
- Neuroradiology (2020) 62:109–127. https://doi.org/10.1007/s00234-019-02317-7
Purpose
The incidence of pertussis has increased due to waning immunity, with disease presentation being less typical and potentially misdiagnosed. Pertussis encephalopathy is an uncommon but serious complication occurring in 0.5%–1% of all cases, but higher in those under 2 years old. Although the exact pathophysiology is unclear, proposed mechanisms include central nervous system hemorrhage due to increased venous pressure from coughing paroxysms, hypoxia, vascular occlusions/venous stasis from high white-blood cell count, hypoglycemia, and exacerbation of unrecognized underlying neurological conditions and effects of toxins produced by B. pertussis, although the organism has never been isolated from CSF. The aim of this paper is to review and acknowledge some of the most frequent neuro-imaging presentations of this rare disease.
Materials and Methods
We present a case of neonatal Bordetella infection, followed by an illustrative CT and MR review. The case was selected from our department’s Neuroradiology database.
Results
The following case presents a 21 days-old infant with respiratory distress due to upper airway infection, followed by tonic seizures. She was admitted to Hospital Dona Estefania and thoroughly examined, with the following findings: leukemoid reaction reaching maximum WBC count of 114000L/mm3 and reactive thrombocytosis; lumbar puncture showing: hyperproteinemia (296,3mg/dL), high cellularity (5/microL) and normal glucose level (91mg/dL) with detection of Bordetella pertussis (by blood PCR). She then performed an MRI showing small lesions affecting white matter bilaterally, most of them with restricted protonic diffusion, related to microinfarcts due to small vessel occlusion.
Conclusion
This case highlights serious complication of pertussis infection and a preventable cause of encephalopathy. It underlines the importance of pertussis immunization in reducing transmission to infants who are at risk of severe complications such as encephalopathy.
Palavras Chave: neonatal pertússis; brain; MRI; DWI; microinfarcts