Neonatal Rotavirus-Associated Leukoencephalopathy: An 11-Case Series Identifying a Stereotyped MRI Diffusion Pattern Independent of Stool Viral Detection

Abstract

Background: Fifth-day seizures in otherwise well term neonates have been associated with rotavirus-associated leukoencephalopathy, but diagnosis is often limited by stool-based testing, particularly when gastrointestinal symptoms are absent or minimal. Objective: To describe the clinical, laboratory, electroencephalographic, and MRI characteristics of neonates with presumed rotavirus-associated encephalopathy and to assess whether a stereotyped DWI/ADC pattern can support diagnosis when stool tests are negative. Methods: We retrospectively reviewed 11 term neonates who presented with seizures on days 4-6 of life, had no evidence of perinatal asphyxia, and underwent brain MRI with diffusion-weighted imaging and apparent diffusion coefficient mapping after sepsis and metabolic evaluation. Stool rotavirus testing was performed using antigen enzyme immunoassay and/or reverse-transcription PCR. Results: The cohort included 7 female and 4 male neonates. Seizures began on day 4 in 8 infants and day 5 in 3; multifocal clonic seizures predominated (7/11). Gastrointestinal symptoms were present in only 1 infant. Sepsis screens, electrolytes, calcium, glucose, and CSF results were non-contributory. Stool testing confirmed rotavirus in 6/11 infants (5 PCR-positive, 1 antigen-positive), while 5 were stool antigen-negative. All 11 infants demonstrated symmetric restricted diffusion involving the periventricular white matter and corpus callosum, with internal capsule involvement in 3/11. All were seizure-free at discharge; length of stay ranged from 10 to 15 days (median 13). Conclusion: In this homogeneous fifth-day seizure cohort, the MRI diffusion signature was more consistent than stool viral detection and should prompt consideration of rotavirus-associated neonatal leukoencephalopathy even when stool testing is negative.