Follow-up studies were conducted in 63 previously healthy children with enterovirus 71 brainstem encephalitis (49 stage II, 7 stage Ilia, and 7 stage Illb) at National Cheng Kung University Hospital, Tainan, Taiwan. Mean time to follow-up was 2.8 +/- 1.0 years (range 1.4-4.9 years). The ratio of boys to girls was 3 to 2. Neurologic abnormalities on admission were altered consciousness (47.6%), cerebellar dysfunction (17.5%), and cranial nerve palsy (15.9%). At follow-up, 51 had no deficits, 3 had died, and 9 (14.3%) had residual deficits, cognitive in 3, cerebellar in 7, and severe motor and respiratory failure in 2. [1]

COMMENT. Nonpolio enterovirus infections are most common in young children, and are spread by fecal-oral and respiratory routes. Enterovirus 71 (EV71) causes hand, foot, and mouh disease or herpangina, but infection can progress to a polio-like, acute flaccid paralysis or brainstem encephalitis (AAP Red Book, 27th ed, 2006;284-5). The rate of CNS complications in Taiwan 1998 epidemic was estimated at 3.1 per 1000 EV71 infections, brainstem encephalitis the most common. The highest mortality occurs in patients with stage Illb and pulmonary edema. Stage II, the most frequent, an isolated brainstem encephalitis, is characterized by myoclonus, ataxia, nystagmus, oculomotor palsies, and bulbar palsy, and stage Ilia, an autonomic nervous system dysregulation, with cold sweats, tachycardia, and hypertension. Close monitoring of cerebellar dysfunction, present in 10% of stage II cases at 3 years after hospitalization, is recommended. Prompt pulmonary resuscitation is necessary in stage Illb cases, to prevent hypoxic-ischemic encephalopathy.