The neurologic complications associated with the 1998 Taiwan enterovirus 71 epidemic are reported from National Cheng Kung University, Tainan; Chang Gung Children’s Hospital, Kaohsiung; and National Defense Medical Center, Taipei, Taiwan. In 41 children with acute neurological manifestations, the mean age was 2.5 years (range, 3 months to 8 years), 28 (68%) had hand-foot-and-mouth disease, 6 (15%) had herpangina, and skin or mucosal lesions were absent in 7. Three neurologic syndromes identified were aseptic meningitis (3 patients {7%}), acute flaccid paralysis (4 {10%}), and brain-stem encephalitis or rhombencephalitis (37 {90%}).

In 37 patients with rhombencephalitis, 86% had myoclonus, and tremor, ataxia, or both were present in 62%. Ocular disturbance occurred in 9 and bulbar palsy in 1. Cardiorespiratory failure developed in 7, and 5 (14% of total) died despite ventilatory support. EEGs showed bilateral slow waves in 5, and MRI had high signal intensity lesions in the brain stem on T2 images of 71%, the frequency of MRI abnormalities increasing with severity of the rhombencephalitis. At follow-up, 14% had neurologic sequelae, including myoclonus, abducens palsy, facial diplegia, ataxia, internuclear ophthalmoplegia, and ventilator-dependent apnea. [1]

COMMENT. Rhombencephalitis is the chief neurologic complication of enterovirus 71 infection in children affected during an epidemic in Taiwan. MRIs show lesions in the brain stem, depending on the severity of the illness, and 14% are fatal. Except for enterovirus 71, enteroviral meningoencephalitis generally has a good prognosis. The infection is characterized by self-limiting fever, vomiting, ulceration of mouth and palate, and vesicular lesions on the hands and feet, but may be followed by aseptic meningitis, meningoencephalitis, or acute flaccid paralysis resembling polio.