Chikungunya virus (CHIKV) infection manifesting in neonates is very rare. The literature on neuroimaging is spares in India as well as worldwide. The first case of neonatal Chikungunya infection by vertical transmission was reported only recently in 2015. Identification of this entity based on neuroimaging findings would help in appropriate management and will aid in prognostication of the affected neonate.

11 neonates including two pairs of twins having chikungunya viral infection in mother and baby diagnosed by serum and CSF real-time reverse transcription–polymerase chain reaction (RT-PCR) method were included in the study. 1.5T MRI brain scan including T1w, T2w, and T2 flair, DWI, ADC sequences of these cases were analyzed for typical neuroimaging findings.

MRI revealed unremarkable features on T1WI and T2WI.  DW images showed confluent hyperintense signals involving bilateral periventricular deep white matter of frontal, parietal, occipital and temporal regions. Corpus callosum, internal and external capsules were involved in all cases. Thalami showed scattered hyperintensites in DW images with peculiar crescent shaped involvement of pulvinar in all cases. Milder cases showed non-confluent patchy involvement with similar pattern and location of lesions.

CONCLUSION

Congenital chickungunya virus encephalitis should be included in differential diagnosis in neonates with non-metabolic encephalopathies with extensive white and gray matter involvement. Specific pattern and location of MRI changes are helpful in diagnosis of congenital chickungunya encephalitis and in limiting workup for large number other disorders having symmetrical involvement of gray and white matter.