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Ludovichetti R, Nierobisch N, Achangwa NR, De Vere-Tyndall A, Fierstra J, Reimann R, Togni C, Terziev R, Galovic M, Kulcsar Z, Hainc N. The split apparent diffusion coefficient sign: A novel magnetic resonance imaging biomarker for cortical pathology with possible implications in autoimmune encephalitis. Neuroradiol J 2024; 37:206-213. [PMID: 38146643 DOI: 10.1177/19714009231224416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
INTRODUCTION MRI is the imaging modality of choice for assessing patients with encephalopathy. In this context, we discuss a novel biomarker, the "split ADC sign," where the cerebral cortex demonstrates restricted diffusion (high DWI signal and low ADC) and the underlying white matter demonstrates facilitated diffusion (high or low DWI signal and high ADC). We hypothesize that this sign can be used as a biomarker to suggest either acute encephalitis onset or to raise the possibility of an autoimmune etiology. MATERIALS AND METHODS A full-text radiological information system search of radiological reports was performed for all entities known to produce restricted diffusion in the cortex excluding stroke between January 2012 and June 2022. Initial MRI studies performed upon onset of clinical symptoms were screened for the split ADC sign. RESULTS 25 subjects were encountered with a positive split ADC sign (15 female; median age = 57 years, range 18-82). Diagnosis included six herpes simplex encephalitis, three peri-ictal MRI changes, eight PRES, two MELAS, and six autoimmune (3 anti-GABAAR, two seronegative, and one anti-Ma2/Ta). Subjects were imaged at a mean 1.8 days after the onset of symptoms (range 0-8). DISCUSSION We present a novel visual MRI biomarker, the split ADC sign, and highlight its potential usefulness in subjects with encephalopathy to suggest acute disease onset or to raise the possibility of an autoimmune etiology when location-based criteria are applied. When positive, the sign was present on the initial MRI and can therefore be used to help focus further clinical and laboratory workup.
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Affiliation(s)
- Riccardo Ludovichetti
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Nathalie Nierobisch
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Ngwe Rawlings Achangwa
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Anthony De Vere-Tyndall
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Regina Reimann
- Institute of Neuropathology, University Hospital of Zurich, University of Zurich, Switzerland
| | - Claudio Togni
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Robert Terziev
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Marian Galovic
- Department of Neurology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Zsolt Kulcsar
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Nicolin Hainc
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
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Reyna RA, Weaver SC. Sequelae and Animal Modeling of Encephalitic Alphavirus Infections. Viruses 2023; 15:v15020382. [PMID: 36851596 PMCID: PMC9959775 DOI: 10.3390/v15020382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Eastern (EEEV), Venezuelan (VEEV), and western equine encephalitis viruses (WEEV) are members of the genus Alphavirus, family Togaviridae. Typically spread by mosquitoes, EEEV, VEEV, and WEEV induce febrile illness that may develop into more severe encephalitic disease, resulting in myriad severe neurologic sequelae for which there are no vaccines or therapeutics. Here, we summarize the clinical neurologic findings and sequelae induced by these three encephalitic viruses and describe the various animal models available to study them. We emphasize the crucial need for the development of advanced animal modeling combined with the use of telemetry, behavioral testing, and neuroimaging to facilitate a detailed mechanistic understanding of these encephalitic signs and sequelae. Through the use of these systems, much-needed therapeutics and vaccines can be developed.
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Affiliation(s)
- Rachel A. Reyna
- Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Scott C. Weaver
- Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555, USA
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX 77555, USA
- Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX 77555, USA
- Correspondence:
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Padayachy L, Ford L, Dlamini N, Mazwi A. Surgical treatment of post-infectious hydrocephalus in infants. Childs Nerv Syst 2021; 37:3397-3406. [PMID: 34148129 DOI: 10.1007/s00381-021-05237-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/27/2021] [Indexed: 11/29/2022]
Abstract
The management of post-infective hydrocephalus in infants remains a challenging task for the pediatric neurosurgeon. The decision-making curve is often complex in that appropriate temporizing measures need to be implemented to properly clear any infection within the CSF before any decision can be made regarding a permanent solution. The etiology differs at varying stages of neonatal development, and the weight of the child, skin fragility, and relevant surgical treatment options are often important limiting factors. Deciding on the optimal treatment option involves assessing the etiology, age, and clinical and radiological features of the individual case and selecting the most appropriate surgical option.
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Affiliation(s)
- L Padayachy
- Pediatric Neurosurgery Unit, Department of Neurosurgery, School of Medicine, Faculty of Health Sciences, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa.
| | - L Ford
- Pediatric Neurosurgery Unit, Department of Neurosurgery, School of Medicine, Faculty of Health Sciences, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
| | - N Dlamini
- Pediatric Neurosurgery Unit, Department of Neurosurgery, School of Medicine, Faculty of Health Sciences, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
| | - A Mazwi
- Department of Neurosurgery, School of Medicine, Faculty of Health Sciences, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
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Case of fatal eastern equine encephalitis. IDCases 2021; 26:e01288. [PMID: 34646732 PMCID: PMC8496102 DOI: 10.1016/j.idcr.2021.e01288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/22/2021] [Indexed: 11/20/2022] Open
Abstract
Eastern Equine Encephalitis (EEE) is a rare and very serious arbovirus that is transmitted to humans through the bite of infected mosquitoes. When symptomatic, patients with this condition are typically seriously ill and the fatality rate is high. We present a fatal case of EEE that exhibited classic symptoms and findings. Included are high quality MRI images that show the classic radiographic findings of this infection. In addition to confirmatory laboratory findings, the case report includes pathologic specimens from brain tissue obtained at autopsy. Perhaps due to climate change and human encroachment on mosquito habitat, there is a westward spread of EEE in the United States.
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Clinical applications of diffusion-weighted sequence in brain imaging: beyond stroke. Neuroradiology 2021; 64:15-30. [PMID: 34596716 PMCID: PMC8484843 DOI: 10.1007/s00234-021-02819-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/10/2021] [Indexed: 11/20/2022]
Abstract
Diffusion-weighted imaging (DWI) is a well-established MRI sequence for diagnosing early stroke and provides therapeutic implications. However, DWI yields pertinent information in various other brain pathologies and helps establish a specific diagnosis and management of other central nervous system disorders. Some of these conditions can present with acute changes in neurological status and mimic stroke. This review will focus briefly on diffusion imaging techniques, followed by a more comprehensive description of the utility of DWI in common neurological entities beyond stroke.
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Ohyagi M, Irioka T, Ohkubo T, Ishibashi S, Takahashi YK, Amano E, Machida A, Kuwahara H, Yokota T. Intrathecal IgG Synthesis and Persistent Inflammation Are Associated with White Matter Lesions in HIV-negative Patients with Cryptococcal Meningoencephalitis. Intern Med 2019; 58:3077-3082. [PMID: 31243232 PMCID: PMC6875458 DOI: 10.2169/internalmedicine.2338-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Cryptococcal meningoencephalitis (CM) causes significant morbidity and mortality in human immunodeficiency virus (HIV)-negative and HIV-positive populations. White matter lesions (WMLs) have been reported in both populations of CM patients; however, the mechanisms underlying WML formation remain unknown. We herein report the relationship between the intrathecal immune response and the development of WMLs in HIV-negative patients with CM. Methods Eleven consecutive HIV-negative patients with CM who presented at one of three emergency hospitals in Japan from April 2001 to March 2018 were enrolled. For all patients, we retrospectively assessed the relationships between clinical and laboratory information and the presence of WMLs. Results At presentation, 6 patients had WMLs on magnetic resonance imaging (MRI). The cerebrospinal fluid immunoglobulin G (CSF IgG) index was significantly higher in the patients with WMLs than in those without WMLs (mean, 1.34 vs. 0.70, p=0.017). The time from the symptom onset to initial neuroimaging was also significantly longer in the patients with WMLs than in those without WMLs (median, 31.5 vs. 7.0 days; p=0.008). The clinical outcome was comparable among the patients with and without WMLs. Conclusion In HIV-negative patients with CM, a persistent, aberrant immune response to Cryptococcus, such as intrathecal IgG synthesis, may induce WML formation.
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Affiliation(s)
- Masaki Ohyagi
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan
| | - Takashi Irioka
- Department of Neurology, Yokosuka Kyosai Hospital, Japan
| | - Takuya Ohkubo
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan
| | - Satoru Ishibashi
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan
| | | | - Eiichiro Amano
- Department of Neurology, Tsuchiura Kyodo General Hospital, Japan
| | - Akira Machida
- Department of Neurology, Tsuchiura Kyodo General Hospital, Japan
| | - Hiroya Kuwahara
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan
| | - Takanori Yokota
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan
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Carney O, Falzon A, MacKinnon A. Diffusion-weighted MRI in paediatric neuroimaging. Clin Radiol 2018; 73:999-1013. [DOI: 10.1016/j.crad.2018.07.101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 07/10/2018] [Indexed: 12/11/2022]
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Koksel Y, Benson J, Huang H, Gencturk M, McKinney AM. Review of diffuse cortical injury on diffusion-weighted imaging in acutely encephalopathic patients with an acronym: "CRUMPLED". Eur J Radiol Open 2018; 5:194-201. [PMID: 30456218 PMCID: PMC6231053 DOI: 10.1016/j.ejro.2018.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 10/21/2018] [Indexed: 02/07/2023] Open
Abstract
Purpose Acute encephalopathic syndromes can present a diagnostic challenge due to the wide range of possible etiologies, which also can have vastly different outcomes. The presence of diffuse cortical injury (DCI) on diffusion-weighted imaging (DWI) can help narrow the differential diagnosis. The aim of this review is to categorize the range of possible etiologies of DCI into a useful acronym, "CRUMPLED". Methods A review of the PACS system was completed to find a characteristic example of patients with DCI on DWI from different etiologies. The diagnosis was confirmed for each example via a subsequent review of the electronic medical record used to assess for data such as biopsy results, laboratory values, and clinical correlation. The electronic exhibit intends to demonstrate several sample cases of each letter within the acronym, and to demonstrate which types of DCI are potentially reversible or irreversible. Findings/Discussion The possible etiologies of DCI on DWI can be organized using the acronym "CRUMPLED": 'C' = Creutzfeldt-jakob disease, 'R' = reversible cerebral vasoconstriction syndrome; 'U' = urea cycle disorders (hyperammonemia) and Uremia; 'M' = mitochondrial (cytopathy/encephalopathy); 'P' = prolonged seizure and posterior reversible encephalopathy (PRES); 'L' = laminar necrosis (hypoxic-ischemic encephalopathy) and liver disease (acute hepatic encephalopathy); 'E' = encephalitis (infectious meningoencephalitis); 'D' = diabetes mellitus (hypoglycemia). Other secondary imaging findings (outside of DWI) can be used to help differentiate between the aforementioned etiologies, such as the use of ADC maps, FLAIR imaging, intravenous contrast. Conclusion "CRUMPLED" is proposed as a convenient acronym for the categorization of a diverse range of acute etiologies associated with DCI on DWI, arising from varying degrees of cytotoxic edema. These etiologies can range from being potentially reversible (e.g. hyperammonemia or prolonged seizures) to irreversible (e.g. hypoxic-ischemic injury).
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Key Words
- AHE, Acute Hepatic/Hyperammonemic Encephalopathy
- Acute encephalopathy
- CJD, Creutzfeldt-Jakob disease
- DCI, Diffuse cortical injury
- DWI
- Diffuse cortical injury
- MELAS, mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes
- PRES, Posterior reversible encephalopathy syndrome
- RCVS, Reversible cerebral vasoconstriction syndrome
- UCD, Urea cycle disorders
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Affiliation(s)
- Yasemin Koksel
- Corresponding author at: Dept. of Radiology, Mayo Building, Univ. of MN, 420 Delaware St. SE, 55418, USA.
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Wakasugi-Sato N, Habu M, Oda M, Tanaka T, Nishida I, Wakasugi T, Kokuryo S, Yoshiga D, Sago T, Harano N, Kito S, Matsumoto-Takeda S, Jyoujima T, Miyamura Y, Yada N, Sasaguri M, Morimoto Y. Characteristics of diffusion-weighted images and apparent diffusion coefficients of ranulas and other masses in and around the floor of the mouth. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:77-84. [PMID: 30292557 DOI: 10.1016/j.oooo.2018.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 08/29/2018] [Accepted: 09/01/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the characteristics of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values of ranulas. In addition, to elucidate DWI findings and ADC values of other representative masses in and around the floor of the mouth. STUDY DESIGN DWI findings and ADC values in 35 patients with ranulas and 33 patients with other masses were retrospectively reviewed with a central focus on cystic masses or lesions that may have cyst-like components in and around the floor of the mouth based on the diagnosis of each respective disease. RESULTS Ranulas were all well-defined, homogeneous masses with high signal intensity on DWI. The mean ± standard deviation ADC value of the 35 ranulas was 2.59 ± 0.31 × 10-3 mm2/s. There was a significant difference in ADC values between simple and plunging ranulas. On DWI, most other masses were heterogeneous, and most ADC values, except those for thyroglossal duct cysts, hemangiomas, and pleomorphic adenomas, were significantly lower than those for ranulas. CONCLUSIONS The characteristic DWI and ADC findings of ranulas can be determined accurately, and these data can be significantly useful in the differential diagnosis of many kinds of diseases in and around the oral floor.
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Affiliation(s)
- Nao Wakasugi-Sato
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - Manabu Habu
- Division of Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - Masafumi Oda
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - Tatsurou Tanaka
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - Ikuko Nishida
- Division of Developmental Stomatognathic Function Science, Kyushu Dental University, Kitakyushu, Japan
| | - Tetsuro Wakasugi
- Division of Otorhinolaryngology-Head and Neck Surgery, University of Environmental Health, Kitakyushu, Japan
| | - Shinya Kokuryo
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - Daigo Yoshiga
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - Teppei Sago
- Division of Dental Anesthesiology, Kyushu Dental University, Kitakyushu, Japan
| | - Nozomu Harano
- Division of Dental Anesthesiology, Kyushu Dental University, Kitakyushu, Japan
| | - Shinji Kito
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | | | - Takaaki Jyoujima
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - Yuichi Miyamura
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan
| | - Naomi Yada
- Division of Oral Pathology, Kyushu Dental University, Kitakyushu, Japan
| | - Masaaki Sasaguri
- Division of Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - Yasuhiro Morimoto
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu, Japan.
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Koeller KK, Shih RY. Viral and Prion Infections of the Central Nervous System: Radiologic-Pathologic Correlation: From the Radiologic Pathology Archives. Radiographics 2017; 37:199-233. [PMID: 28076019 DOI: 10.1148/rg.2017160149] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Viral infections of the central nervous system (CNS) range in clinical severity, with the most severe proving fatal within a matter of days. Some of the more than 100 different viruses known to affect the brain and spinal cord are neurotropic with a predilection for producing CNS infection. The host response to viral infection of the CNS is responsible for the pathophysiology and imaging findings seen in affected patients. Viral CNS infections can take the form of meningitis, encephalitis, encephalomyelitis, or, when involving the spinal cord and nerve roots, encephalomyeloradiculitis. In 1982, an infectious particle termed a prion that lacked nucleic acid and therefore was not a virus was reported to produce the fatal neurodegenerative disease Creutzfeldt-Jakob disease and related disorders. These prion diseases produce characteristic neuroimaging findings that are distinct from those seen in most viral infections. The clinical and imaging findings associated with viral CNS infection are often nonspecific, with microbiologic analysis of cerebrospinal fluid the most useful single test allowing for diagnosis of a specific viral infection. This review details the spectrum of viral CNS infections and uses case material from the archives of the American Institute for Radiologic Pathology, with a focus on the specific clinical characteristics and magnetic resonance imaging features seen in these infections. Where possible, the imaging features that allow distinction of these infections from other CNS inflammatory conditions are highlighted.
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Affiliation(s)
- Kelly K Koeller
- From the Department of Neuroradiology, American Institute for Radiologic Pathology, Silver Spring, Md (K.K.K., R.Y.S.); Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (K.K.K.); Uniformed Services University of the Health Sciences, Bethesda, Md (R.Y.S.); and Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (R.Y.S.)
| | - Robert Y Shih
- From the Department of Neuroradiology, American Institute for Radiologic Pathology, Silver Spring, Md (K.K.K., R.Y.S.); Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (K.K.K.); Uniformed Services University of the Health Sciences, Bethesda, Md (R.Y.S.); and Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (R.Y.S.)
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Comparison of intravoxel incoherent motion diffusion-weighted imaging between turbo spin-echo and echo-planar imaging of the head and neck. Eur Radiol 2017; 28:316-324. [DOI: 10.1007/s00330-017-4990-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/25/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
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Katirag A, Beker-Acay M, Unlu E, Demirbas H, Demirturk N. Apparent Diffusion Coefficient analysis of encephalitis: A comparative study with topographic evaluation and conventional MRI findings. Pak J Med Sci 2016; 32:725-30. [PMID: 27375722 PMCID: PMC4928431 DOI: 10.12669/pjms.323.10030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: Our purpose was to reveal the efficiency of diffusion weighted imaging (DWI) in the diagnosis of encephalitis, and to determine the relation between the apparent diffusion coefficient (ADC) values, the onset of the clinical symptoms, and the lesion extent. Methods: Conventional magnetic resonance imaging (MRI) was performed in 17 patients with encephalitis diagnosed on the basis of laboratory, clinical and radiologic findings during 2009 and 2015. Based on the duration between the onset of the symptoms and the brain MRI findings, the patients were divided into three groups. ADC values of the encephalitis lesion, the lesions’ topographic analysis score, deep gray matter involvement, patients’ clinical situation and the duration of the arrival to the clinic was examined. Results: Mean ADC values were 0,988±0,335 x10-3 mm2/s in group I (0-2 days), 1,045±0,347 x10-3 mm2/s in Group-II (3-7 days), 1,451±0,225 x10-3 mm2/s in Group-III (8 days and over). The relation between the ADC values and the duration of the arrival, topographic analysis score, the relation between the patients’ clinical situation and the deep gray matter involvement were found to be statistically significant. The deep gray matter involvement was demonstrated more clearly by FLAIR images when compared with DWI. Conclusion: Conventional MRI sequences may be insufficient in showing the encephalitis lesion. DWI must be added to the imaging modalities immediately in the cases suspected of having encephalitis.
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Affiliation(s)
- Ahmet Katirag
- Ahmet Katirag, MD. Resident Assistant, Department of Radiology, Afyon Kocatepe University Faculty of Medicine, Afyonkarahisar, Turkey
| | - Mehtap Beker-Acay
- Mehtap Beker-Acay, MD. Assistant Professor, Department of Radiology, Afyon Kocatepe University Faculty of Medicine, Afyonkarahisar, Turkey
| | - Ebru Unlu
- Ebru Unlu, MD. Assistant Professor, Department of Radiology, Afyon Kocatepe University Faculty of Medicine, Afyonkarahisar, Turkey
| | - Hayri Demirbas
- Hayri Demirbas M.D. Assistant Professor, Department of Neurology, Afyon Kocatepe University Faculty of Medicine, Afyonkarahisar, Turkey
| | - Nese Demirturk
- Nese Demirturk MD. Associate Professor, Department of Infectious Diseases, Afyon Kocatepe University Faculty of Medicine, Afyonkarahisar, Turkey
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Jordan B, Kösling S, Emmer A, Koch A, Müller T, Kornhuber M. A study on viral CNS inflammation beyond herpes encephalitis. J Neurovirol 2016; 22:763-773. [PMID: 27173398 DOI: 10.1007/s13365-016-0452-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/16/2016] [Accepted: 05/02/2016] [Indexed: 02/06/2023]
Abstract
The early diagnosis of herpes simplex virus encephalitis (HSVE) enables induction of antiviral therapy in this potentially life-threatening disease. The study aimed to determine clinical findings including cerebrospinal fluid (CSF) data and MRI imaging in HSVE patients and to identify features distinguishing HSVE from encephalitis of other viral etiologies. We retrospectively reviewed consecutive patients who were diagnosed with viral encephalitis between 2000 and 2014 at the University Hospital Halle. Forty-nine patients with viral encephalitis were identified. A viral etiology could be confirmed by PCR or antibody testing in 22/49 (44.9 %) of patients (15 (30.6 %) HSV, 5 (10.2 %) VZV, 2 (4.1 %) EBV). In HSVE, typical findings were focal slowing in electroencephalophy (EEG) (80 %, p = 0.021) and presence of cortical (86.7 %, p = 0.030) lesions in MRI. Restricted diffusion was particularly helpful in detection of early signal abnormalities in HSVE (p = 0.014). In 27/49 (55.1 %) of patients, no causative agent could be elucidated. In these patients, 15/27 (55.6 %) experienced a rather "benign" disease course with no MRI pathology despite initially HSVE mimicking clinical picture. However, CSF was significantly different showing a higher amount of granulocytes and activated lymphocytes. The remaining 12/27 (44.4 %) patients developed MRI changes consistent with encephalitis, in 4 of these patients, disease course was fatal. Beside PCR-based serology as standard procedure, MRI including diffusion-weighted images and EEG represent additional tools in early HSVE diagnosis. CSF cytology might be particularly supportive in differentiating likely benign forms of encephalitis.
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Affiliation(s)
- Berit Jordan
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06097, Halle/Saale, Germany.
| | - Sabrina Kösling
- Department of Radiology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06097, Halle/Saale, Germany
| | - Alexander Emmer
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06097, Halle/Saale, Germany
| | - Antje Koch
- Dermatology Outpatient Clinic Magdeburg, Magdeburg, Germany
| | - Tobias Müller
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06097, Halle/Saale, Germany
| | - Malte Kornhuber
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06097, Halle/Saale, Germany
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Nam IC, Kim SH, Kim SJ, Lim YJ. Added Value of Diffusion Weighted Imaging for Detecting Pancreatic Abnormality in Patients with Clinically Suspected Acute Pancreatitis. ACTA ACUST UNITED AC 2016. [DOI: 10.13104/imri.2016.20.4.241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- In Chul Nam
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Seung Ho Kim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Seon-Jeong Kim
- Department of Radiology, Myongji Hospital, Goyang-si, Korea
| | - Yun-jung Lim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
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Wong AM, Lin JJ, Toh CH, Bilaniuk LT, Zimmerman RA, Chang YC, Lin KL, Wang HS. Childhood encephalitis: relationship between diffusion abnormalities and clinical outcome. Neuroradiology 2014; 57:55-62. [DOI: 10.1007/s00234-014-1449-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 09/29/2014] [Indexed: 12/01/2022]
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16
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Kim B, Yi K, Jung S, Ji S, Choi M, Yoon J. Clinical applications and characteristics of apparent diffusion coefficient maps for the brain of two dogs. J Vet Sci 2014; 15:455-8. [PMID: 24675836 PMCID: PMC4178150 DOI: 10.4142/jvs.2014.15.3.455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 02/22/2014] [Indexed: 11/20/2022] Open
Abstract
Diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) mapping are functional magnetic resonance imaging techniques for detecting water diffusion. DWI and the ADC map were performed for intracranial lesions in two dogs. In necrotizing leukoencephalitis, cavitated lesions contained a hypointense center with a hyperintense periphery on DWI, and hyperintense signals on the ADC maps. In metastatic sarcoma, masses including a necrotic region were hypointense with DWI, and hyperintense on the ADC map with hyperintense perilesional edema on DWI and ADC map. Since DWI and ADC data reflect the altered water diffusion, they can provide additional information at the molecular level.
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Affiliation(s)
- Boeun Kim
- College of Veterinary Medicine and the Research Institute for Veterinary Science at Seoul National University, Seoul 151-742, Korea
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Mahan M, Karl M, Gordon S. Neuroimaging of viral infections of the central nervous system. HANDBOOK OF CLINICAL NEUROLOGY 2014; 123:149-73. [PMID: 25015484 DOI: 10.1016/b978-0-444-53488-0.00006-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Mathur Mahan
- Department of Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Muchantef Karl
- Department of Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Sze Gordon
- Department of Radiology, Yale University School of Medicine, New Haven, CT, USA.
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Brain perfusion SPECT in limbic encephalitis associated with autoantibody against the glutamate receptor epsilon 2. Clin Neurol Neurosurg 2013; 118:44-8. [PMID: 24529228 DOI: 10.1016/j.clineuro.2013.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 12/14/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aim of this study was to elucidate the single-photon emission computed tomography (SPECT) pattern at the acute stage of disease in non-herpetic limbic encephalitis (NHLE) patients associated with the N-methyl-D-aspartate-type glutamate receptor epsilon 2 (GluR ϵ2) autoantibody using Z-score imaging system (eZIS) analyses. METHODS Brain magnetic resonance imaging (MRI) and brain perfusion SPECT using technetium-99 ethyl cysteinate dimer ((99m)Tc-ECD) were performed in eight patients with NHLE (5 men and 3 women; mean age 48.8±22 years) within 20days after clinical onset. RESULTS All patients had various clinical limbic-associated symptoms and no evidence of herpes simplex infection or systemic malignancies. Two of eight patients showed abnormally hyperintense lesions on diffusion-weighted images and significant hyperperfusion in ipsilateral cerebral cortex on eZIS analysis, whereas other patients showed normal MRI findings and significant hypoperfusion in one or both sides of the limbic and paralimbic areas. CONCLUSION We suggest that (99m)Tc-ECD SPECT study using eZIS analyses may be helpful to detect the neuronal dysfunction, particularly in NHLE patients without abnormal MRI findings.
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Abstract
Infection of the central nervous system can be life-threatening and hence requires early diagnostic support for its optimal management. Routine definitive laboratory diagnostic tests can be time-consuming and delay definitive therapy. Noninvasive imaging modalities have established themselves in the diagnosis of various neurologic diseases. In this article, a pragmatic review of the current role of magnetic resonance spectroscopy in the diagnosis and management of intracranial infections is addressed.
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Affiliation(s)
- Rakesh K Gupta
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India.
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Chen HW, Ding LW, Lai CC, Tseng TK, Liu WL. Japanese viral encephalitis mimicking stroke with an initial manifestation of hemiplegia. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2012; 45:465-7. [DOI: 10.1016/j.jmii.2011.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 05/15/2010] [Accepted: 07/20/2010] [Indexed: 11/27/2022]
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Iwanaga N, Nakamura S, Tanaka A, Fukuda Y, Imamura Y, Miyazaki T, Izumikawa K, Kakeya H, Yamamoto Y, Yanagihara K, Soda H, Tashiro T, Kohno S. [An adult case of influenza-associated encephalitis successfully treated with high dose intravenous immunoglobulins]. ACTA ACUST UNITED AC 2012; 86:295-9. [PMID: 22746053 DOI: 10.11150/kansenshogakuzasshi.86.295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A 73-year-old man was admitted to our hospital with a high fever and left paresis. A rapid diagnosis test was positive for influenza A was positive by rapid diagnosis test and diffusion-weighted MRI imaging of the brain showed a high intensity lesion of the right cerebral peduncle. The patient was therefore diagnosed as having influenza A virus infection complicated with lacunar infarction. In spite of initial treatment with oseltamivir and anticoagulant therapy, he lost consciousness eight hours after admission. The high intensity lesion of the cerebral peduncle enlarged and new lesions in the thalamus, hippocampus and calcarine cortex were detected with brain MRI. Additionally, an electroencephalographic study showed an entire slow wave and as the other causative pathogens of central nerve system infection were not detected, the likely diagnosis was influenza-associated encephalitis. We administered a high dose of intravenous immunoglobulin since the low-grade fever and mild unconscious state had continued in spite of the treatment with methylprednisolone pulse therapy. His consciousness was restored and body temperature became normal immediately. We could confirm the efficacy of our treatment by measurement of IL-6 levels in the serum and cerebrospinal fluid during the entire clinical course. In conclusion, a high dose of intravenous immunoglobulin therapy might be one of the effective treatments for influenza-associated encephalitis.
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Kawamura N, Kizawa M, Ueda A, Niimi Y, Mutoh T. An update on diagnostic imaging studies for viral encephalitis. Future Virol 2012. [DOI: 10.2217/fvl.12.75] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Viral encephalitis is still a life-threatening disease occurring at any age. It is critical to make a rapid and correct diagnosis for a better outcome of the disease. Accumulating evidence has suggested that MRI is a powerful tool for the detection of any lesion of the CNS caused by viral infections and helps to initiate the timely treatment. In this review, we summarize the current understanding of MRI findings of viral encephalitis, especially related to HSV, HIV, varicella zoster, Japanese encephalitis, John Cunningham, and influenza viruses. With these considerations, we learnt that the inclusion of diffusion-weighted image sequences on routine MRI examination would have a significant value in detecting the pathologic changes that occur following viral invasion of the CNS.
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Affiliation(s)
- Naoki Kawamura
- Department of Neurology, Fujita Health University School of Medicine, Aichi, Japan
| | - Madoka Kizawa
- Department of Neurology, Fujita Health University School of Medicine, Aichi, Japan
| | - Akihiro Ueda
- Department of Neurology, Fujita Health University School of Medicine, Aichi, Japan
| | - Yoshiki Niimi
- Department of Neurology, Fujita Health University School of Medicine, Aichi, Japan
| | - Tatsuro Mutoh
- Department of Neurology, Fujita Health University School of Medicine, Aichi, Japan
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Clinico-radiological features of subarachnoid hyperintensity on diffusion-weighted images in patients with meningitis. Clin Radiol 2011; 67:306-12. [PMID: 22192625 DOI: 10.1016/j.crad.2011.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 09/22/2011] [Accepted: 10/03/2011] [Indexed: 11/21/2022]
Abstract
AIM To investigate the clinical and radiological features of meningitis with subarachnoid diffusion-weighted imaging (DWI) hyperintensity. MATERIALS AND METHODS The clinical features, laboratory data, and radiological findings, including the number and distribution of subarachnoid DWI hyperintense lesions and other radiological abnormalities, of 18 patients seen at five institutions were evaluated. RESULTS The patients consisted of eight males and 10 females, whose ages ranged from 4 months to 82 years (median 65 years). Causative organisms were bacteria in 15 patients, including Haemophilus influenzae, Streptococcus pneumoniae, Streptococcus agalactiae, Staphylococcus aureus, Klebsiella pneumoniae, and Listeria monocytogenes. The remaining three were fungal meningitis caused by Cryptococcus neoformans. Subarachnoid DWI hyperintense lesions were multiple in 16 of the 18 cases (89%) and predominantly distributed around the frontal lobe in 16 of the 18 cases (89%). In addition to subarachnoid abnormality, subdural empyema, cerebral infarction, and intraventricular empyema were found in 50, 39, and 39%, respectively. Compared with paediatric patients, adult patients with bacterial meningitis tended to have poor prognoses (7/10 versus 1/5; p = 0.1). CONCLUSION Both bacterial and fungal meningitis could cause subarachnoid hyperintensity on DWI, predominantly around the frontal lobe. This finding is often associated with poor prognosis in adult bacterial meningitis.
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Two patients with acute rotavirus encephalitis associated with cerebellar signs and symptoms. Eur J Pediatr 2010; 169:1287-91. [PMID: 20461531 DOI: 10.1007/s00431-010-1202-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 04/13/2010] [Indexed: 10/19/2022]
Abstract
Rotavirus, one of the major causes of severe gastroenteritis in children, occasionally causes central nervous system complications. Recently several patients with acute encephalitis/encephalopathy due to rotavirus associated with cerebellar signs and symptoms have been reported. The condition is characterized by disturbances of consciousness at onset and cerebellar signs and symptoms such as hypotonia, ataxia, dysmetria, and speech disorders, including mutism, slow speech, and dysarthria at convalescence. We report two patients (3-year-old girl, 2-year-old boy) who developed acute encephalitis due to rotavirus and showed cerebellar signs and symptoms. Both patients had characteristic history of consciousness disturbances subsequent to several days of diarrhea, vomiting and fever, and cerebellar symptoms such as hypotonia, ataxia, dysmetria, and speech disorders during the recovery period. Electroencephalography showed diffuse high-voltage delta wave activity in each patient. Brain magnetic resonance imaging showed cerebellar edema in the acute phase followed by cerebellar atrophy on follow-up images in both patients. In the first patient, diffusion-weighted images (DWI) revealed high signals at the left cerebellar peduncle region and apparent diffusion coefficient (ADC) maps showed decreased ADC values of the lesion in the acute phase. The first patient had dysmetria at 1-year follow-up. However, she had normal motor and cognitive functions and could lead her daily life without impairment. In the second patient, no further symptoms were apparent at 1-year follow-up. Acute encephalitis/encephalopathy due to rotavirus with cerebellar signs and symptoms might be diagnosed on DWI, by demonstrating decreased ADC values in acute phase.
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CT and MRI findings of human herpesvirus 6-associated encephalopathy: comparison with findings of herpes simplex virus encephalitis. AJR Am J Roentgenol 2010; 194:754-60. [PMID: 20173155 DOI: 10.2214/ajr.09.2548] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE It is important to differentiate human herpesvirus 6 (HHV-6)-associated encephalopathy from herpes simplex encephalitis (HSE). Although these conditions are similar with regard to involvement of the mesial temporal lobe, HSE is sensitive to acyclovir but HHV-6 encephalopathy is not. We compared the imaging findings of the two conditions. MATERIALS AND METHODS We encountered eight cases of HHV-6 encephalopathy and nine cases of HSE. We divided an observation time into early, middle, and late periods defined as 0-2, 3-30, and more than 30 days from the onset of neurologic symptoms. Differences between HHV-6 encephalopathy and HSE on CT scans in the early period and in distribution and temporal changes in the affected regions on MR images in the three periods were analyzed. RESULTS At MRI in the early and middle periods, all eight patients with HHV-6 encephalopathy had exclusive involvement of the mesial temporal lobes, and all nine patients with HSE had involvement of both the mesial temporal lobes and the extratemporal regions (p < 0.01). Among patients who underwent head MRI, six of six with HHV-6 encephalopathy but none of six with HSE had resolution of high signal intensity on T2-weighted and FLAIR images (p < 0.01). Among patients who underwent head CT in the early period, none of the four with HHV-6 encephalopathy and six of the seven with HSE had abnormal findings, including parenchymal swelling, decreased attenuation of affected regions, and abnormal gyral enhancement (p < 0.05). CONCLUSION Serial MRI showed transient abnormal signal intensity in the mesial temporal lobes in patients with HHV-6 encephalopathy but persistent abnormal signal intensity in both the mesial temporal lobes and the extratemporal regions in patients with HSE. CT in the early period showed no abnormality in patients with HHV-6 encephalopathy but definite abnormal findings in patients with HSE. These differences may be useful in the differential diagnosis of the two conditions.
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Steiner I, Budka H, Chaudhuri A, Koskiniemi M, Sainio K, Salonen O, Kennedy PGE. Viral meningoencephalitis: a review of diagnostic methods and guidelines for management. Eur J Neurol 2010; 17:999-e57. [PMID: 20236175 DOI: 10.1111/j.1468-1331.2010.02970.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Viral encephalitis is a medical emergency. The prognosis depends mainly on the pathogen and host immunologic state. Correct immediate diagnosis and introduction of symptomatic and specific therapy has a dramatic influence upon survival and reduces the extent of permanent brain injury. METHODS We searched the literature from 1966 to 2009. Recommendations were reached by consensus. Where there was lack of evidence but consensus was clear, we have stated our opinion as good practice points. RECOMMENDATIONS Diagnosis should be based on medical history and examination followed by CSF analysis for protein and glucose levels, cellular analysis, and identification of the pathogen by polymerase chain reaction amplification (recommendation level A) and serology (level B). Neuroimaging, preferably by MRI, is essential (level B). Lumbar puncture can follow neuroimaging when immediately available, but if this cannot be performed immediately, LP should be delayed only under unusual circumstances. Brain biopsy should be reserved only for unusual and diagnostically difficult cases. Patients must be hospitalized with easy access to intensive care units. Specific, evidence-based, antiviral therapy, acyclovir, is available for herpes encephalitis (level A) and may also be effective for varicella-zoster virus encephalitis. Ganciclovir and foscarnet can be given to treat cytomegalovirus encephalitis, and pleconaril for enterovirus encephalitis (IV class evidence). Corticosteroids as an adjunct treatment for acute viral encephalitis are not generally considered to be effective, and their use is controversial, but this important issue is currently being evaluated in a large clinical trial. Surgical decompression is indicated for impending uncal herniation or increased intracranial pressure refractory to medical management.
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Affiliation(s)
- I Steiner
- Department of Neurology, Rabin Medical Center, Beilinson Campus, Petach Tiqva, Israel.
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Kumar G, Kalita J, Misra UK. Raised intracranial pressure in acute viral encephalitis. Clin Neurol Neurosurg 2009; 111:399-406. [DOI: 10.1016/j.clineuro.2009.03.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 03/10/2009] [Accepted: 03/11/2009] [Indexed: 12/12/2022]
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Low RN. Diffusion-Weighted MR Imaging for Whole Body Metastatic Disease and Lymphadenopathy. Magn Reson Imaging Clin N Am 2009; 17:245-61. [DOI: 10.1016/j.mric.2009.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Chronic unilateral neglect from focal meningoencephalitis lesions in an immune-compromised hemodialysis patient. J Neurosci Nurs 2009; 40:326-32. [PMID: 19170298 DOI: 10.1097/01376517-200812000-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Unilateral neglect (UN) is a disorder associated primarily with right-brain damage; it causes individuals to behave as if the contralesional half of their world has become unimportant or has simply ceased to exist. This is the first known case study to describe and measure UN caused by an infectious process, meningoencephalitis. The patient was immune compromised as a result of antirejection drugs following a kidney and pancreas transplant, as well as from a baseline vulnerability common to patients with hemodialysis. She was reassessed serially during hemodialysis treatments over 12 months and demonstrated improvement in some measures of UN but not in others. UN is a recognized nursing diagnosis and can be assessed, treated, and researched by nurses. Neuroscience nurses need to better understand and investigate UN to improve their own practice and the practice of other specialties.
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Lim CCT, Gan R, Chan CL, Tan AWK, Khoo JJC, Chia SY, Kao SL, Abisheganaden J, Sitoh YY. Severe hypoglycemia associated with an illegal sexual enhancement product adulterated with glibenclamide: MR imaging findings. Radiology 2008; 250:193-201. [PMID: 19017925 DOI: 10.1148/radiol.2493080795] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To describe the magnetic resonance (MR) imaging findings associated with severe hypoglycemia after consumption of an illegal sexual enhancement product (Power 1 Walnut) adulterated with glibenclamide, an oral hypoglycemic agent used to treat diabetes mellitus. MATERIALS AND METHODS Institutional review board approval was obtained for this retrospective study. Records in eight male patients with severe hypoglycemia of unknown cause, without prior treatment for diabetes, and with positive blood toxicology results for glibenclamide were reviewed. MR imaging included diffusion-weighted imaging and, in some patients, MR angiography, dynamic contrast material-enhanced perfusion MR imaging, and MR spectroscopy. RESULTS In seven patients, there were hyperintense abnormalities on diffusion-weighted and T2-weighted images in the hippocampus and cerebral cortex, sparing the subcortical white matter and cerebellum. Three patients had abnormalities of the splenium of the corpus callosum, and one had widespread involvement, including the caudate nucleus, basal ganglia, and internal capsule bilaterally. In three patients, unilateral cortical involvement, which did not conform to the typical cerebral arterial territories, was noted. In one patient, perfusion MR imaging showed slightly increased relative cerebral blood volume, and MR spectroscopy revealed no evidence of abnormal lactate in the affected cerebral cortex. CONCLUSION Diffusion-weighted MR imaging findings in patients with severe hypoglycemia showed typical lesions in the hippocampus and cerebral cortex, but the caudate nucleus and basal ganglia were involved in only the most severely affected patient. The splenium of the corpus callosum and internal capsule were also abnormal in three patients, and unilateral cortical lesions could be distinguished from acute ischemic stroke by the pattern of involvement and MR angiographic, perfusion, and spectroscopic findings.
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Affiliation(s)
- C C Tchoyoson Lim
- Department of Neuroradiology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
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Bulakbasi N, Kocaoglu M. Central nervous system infections of herpesvirus family. Neuroimaging Clin N Am 2008; 18:53-84; viii. [PMID: 18319155 DOI: 10.1016/j.nic.2007.12.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Herpesviruses are one of the most common groups of pathogens causing central nervous system infections in humans. They mostly cause encephalitis, meningitis, or myelitis in immunocompetent and immunocompromised patients. Children, adults, and the elderly can all be affected. Although contrast-enhanced CT is more widely used for diagnosis, contrast-enhanced MR imaging combined with diffusion-weighted imaging is superior to CT in the detection of early changes and the real extent of the disease, and in assessing prognosis and monitoring response to antiviral treatment. More sophisticated techniques, such as MR spectroscopy and perfusion imaging, can aid in the differential diagnosis of herpesvirus infections from other tumoral, demyelinating, and ischemic processes.
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Affiliation(s)
- Nail Bulakbasi
- Department of Radiology, Gulhane Military Medical Academy and School of Medicine, Etlik, Ankara 06018, Turkey.
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Abnormal Diffusion-Weighted Imaging Findings in an Adult Patient With Acute Cerebellitis Presenting With a Normal Magnetic Resonance Imaging. J Comput Assist Tomogr 2008; 32:156-8. [DOI: 10.1097/rct.0b013e3180653c8a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Obeid M, Franklin J, Shrestha S, Johnson L, Quattromani F, Hurst D. Diffusion-weighted imaging findings on MRI as the sole radiographic findings in a child with proven herpes simplex encephalitis. Pediatr Radiol 2007; 37:1159-62. [PMID: 17874320 DOI: 10.1007/s00247-007-0577-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Revised: 06/19/2007] [Accepted: 07/03/2007] [Indexed: 12/01/2022]
Abstract
We present a case of herpes simplex encephalitis in an 8-year-old girl, in whom hyperintensity was detected on diffusion-weighted imaging (DWI) while conventional MRI sequences were normal 1 week after the onset of neurological symptoms. This case is rare in that a child beyond the neonatal period with focal herpes simplex encephalitis had an abnormal DWI sequence as the only MRI finding.
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Affiliation(s)
- Makram Obeid
- Department of Pediatrics, Texas Tech University Health Sciences Center, 3601 4th St., Lubbock, TX 79430, USA.
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Al-Okaili RN, Krejza J, Wang S, Woo JH, Melhem ER. Advanced MR Imaging Techniques in the Diagnosis of Intraaxial Brain Tumors in Adults. Radiographics 2006; 26 Suppl 1:S173-89. [PMID: 17050514 DOI: 10.1148/rg.26si065513] [Citation(s) in RCA: 183] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Intraaxial brain masses are a significant health problem and present several imaging challenges. The role of imaging is no longer limited to merely providing anatomic details. Sophisticated magnetic resonance (MR) imaging techniques allow insight into such processes as the freedom of water molecule movement, the microvascular integrity and hemodynamic characteristics, and the chemical makeup of certain compounds of masses. The role of the most commonly used advanced MR imaging techniques-perfusion imaging, diffusion-weighted imaging, and MR spectroscopy-in the diagnosis and classification of the most common intraaxial brain tumors in adults is explored. These lesions include primary neoplasms (high- and low-grade), secondary (meta-static) neoplasms, lymphoma, tumefactive demyelinating lesions, abscesses, and encephalitis. Application of a diagnostic algorithm that integrates advanced MR imaging features with conventional MR imaging findings may help the practicing radiologist make a more specific diagnosis for an intraaxial tumor.
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Affiliation(s)
- Riyadh N Al-Okaili
- Department of Radiology, University of Pennsylvania School of Medicine, 3400 Spruce St, Dulles 2, Philadelphia, PA 19104, USA
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Kiroğlu Y, Calli C, Yunten N, Kitis O, Kocaman A, Karabulut N, Isaev H, Yagci B. Diffusion-weighted MR imaging of viral encephalitis. Neuroradiology 2006; 48:875-80. [PMID: 16944118 DOI: 10.1007/s00234-006-0143-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2006] [Accepted: 07/24/2006] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the role of diffusion-weighted imaging (DWI) in the diagnosis of viral encephalitis and its relationship with the stage of the illness. METHODS We performed conventional magnetic resonance imaging (MRI) including T1-W, T2-W and fluid attenuated inversion recovery (FLAIR) sequences and DWI in 18 patients with viral encephalitis diagnosed on the basis of laboratory, clinical and radiologic findings. Based on the qualitative and quantitative comparison of the conventional MRI and DWI, the patients were divided into three groups. Apparent diffusion coefficient (ADC) values of the involved and contralateral normal brain tissues were computed and compared for each group. The degree of correlation between the time (TI) from the onset of neurologic symptoms to the MR examination and ADC values was determined. RESULTS In group I (n=11) DWI was superior to conventional MRI in detecting the encephalitic involved sites and in depicting the borders of the encephalitic lesions. In group II (n=4) DWI was similar to conventional MRI. In group III (n=3) conventional MRI was superior to DWI. Mean ADC values of affected versus contralateral normal brain tissues were 0.458+/-0.161 x 10(-3) versus 0.86+/-0.08 x 10(-3) in group I, 0.670+/-0.142 x 10(-3) versus 0.93+/-0.07 x 10(-3) in group II, and 1.413+/-0.211 x 10(-3) versus 1.05+/-0.06 x 10(-3) in group III. Patients in group I had significantly lower ADC values than those in group II, while patients in group III had the highest ADC values (P<0.05). The ADC values were significantly lower in the affected sites than in the unaffected sites of patients in groups I and II, but were significantly higher in the affected sites than in the unaffected sites of patients in group III (P<0.05). There was an excellent correlation between ADC values and duration of the disease (r=0.874, P=0.01). CONCLUSION DWI is superior to other conventional diagnostic MR sequences in the detection of early viral encephalitic lesions and depiction of the lesion borders and, in combination with other sequences, DWI may contribute to the determination of the disease phase.
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Affiliation(s)
- Yilmaz Kiroğlu
- Department of Radiology, Pamukkale University School of Medicine, TR-20070 Denizli, Turkey.
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La Tessa G, Tedeschi E, Covelli E, Pasqualetto L, Cirillo M, Belfiore G. Acute Encephalitis of Unknown Etiology: Early Diagnosis and Follow-up of Disease Evolution. MRI. Neuroradiol J 2006; 19:313-21. [DOI: 10.1177/197140090601900307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Accepted: 05/11/2006] [Indexed: 11/17/2022] Open
Abstract
Two women with viral encephalitis of unknown etiology were studied with serial MR studies at 1.5 Tesla using: Spin-Echo (SE) T1-weighted (T1w) sequences before and after i.v. administration of paramagnetic contrast agent, with/without magnetization transfer (MT), Fast SE and Fluid-attenuated Inversion Recovery (FLAIR) T2-weighted sequences, Echo-Planar Single-Shot sequences for the assessment of water diffusivity (Diffusion Weighted, DW, and Apparent Diffusion Coefficient maps, ADC). The DW and T1w sequences with MT after contrast were most useful to detect the initial pathologic alterations, thereby reinforcing the clinical diagnostic hypothesis and prompting appropriate drug treatment, even if the laboratory data were not conclusive for viral etiology. In a later phase, both cases showed MR evidence of lacunar foci in the grey matter, and cortical laminar necrosis, probably indicating a concomitant hypoxic/ischemic mechanism.
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Affiliation(s)
| | - E. Tedeschi
- Dipartimento di Diagnostica per Immagini, AORN S. Sebastiano, Caserta
| | - E.M. Covelli
- Dipartimento di Diagnostica per Immagini, AORN S. Sebastiano, Caserta
| | | | - M. Cirillo
- Cattedra di Neuroradiologia, II Università degli Studi di Napoli; Italy
| | - G. Belfiore
- Dipartimento di Diagnostica per Immagini, AORN S. Sebastiano, Caserta
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38
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Cruz LCH, Sorensen AG. Diffusion Tensor Magnetic Resonance Imaging of Brain Tumors. Magn Reson Imaging Clin N Am 2006; 14:183-202. [PMID: 16873010 DOI: 10.1016/j.mric.2006.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
DTI seems to offer the possibility of adding important information to presurgical planning. Although experience is limited, DTI seems to provide useful local information about the structures near the tumor, and this seems to be useful in planning. In the future, DTI may provide an improved way to monitor intraoperative surgical procedures as well as their complications. Furthermore, evaluation of the response to treatment with chemotherapy and radiation therapy might also be possible. Although DTI has some limitations, its active investigation and further study are clearly warranted.
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Affiliation(s)
- L Celso Hygino Cruz
- Clínica de Diagnóstico por Imagem, Multi-Imagem Ressonância Magnética, Av. das Ameréricas 4666, Centro Médico Barrashopping, Rio de Janeiro, Brazil
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39
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Yoshikawa H, Kitamura T. Serial changes on diffusion-weighted magnetic resonance imaging in encephalitis or encephalopathy. Pediatr Neurol 2006; 34:308-11. [PMID: 16638508 DOI: 10.1016/j.pediatrneurol.2005.08.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2005] [Revised: 07/28/2005] [Accepted: 08/19/2005] [Indexed: 11/29/2022]
Abstract
It is recognized that diffusion-weighted magnetic resonance imaging is a sensitive method of detecting cerebral lesions in various neurologic disorders. This report presents two patients with acute encephalitis or encephalopathy who manifested similar serial changes on diffusion-weighted magnetic resonance imaging. Clinically, Patient 1, a 2-year-old male, was diagnosed as having hemiconvulsion-hemiplegia-epilepsy syndrome and Patient 2, a 9-month-old male, acute encephalitis associated with exanthema subitum. Despite the different etiology and the distribution of lesions, diffusion-weighted magnetic resonance imaging of these two patients revealed high-intensity lesions in the subcortical white matter in the acute phase, and then in the cortex, or basal ganglia, or both. In the convalescent phase, high-intensity lesions disappeared and brain atrophy developed. These serial changes were not recognized using other conventional methods. Although the exact mechanism for these serial changes remains unknown, these changes might reflect some pathogenic mechanism in acute encephalopathy or encephalitis.
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Affiliation(s)
- Hideto Yoshikawa
- Department of Neurology, Miyagi Children's Hospital, Miyagi, Sendai, Japan.
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40
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Kitis O, Altay H, Calli C, Yunten N, Akalin T, Yurtseven T. Minimum apparent diffusion coefficients in the evaluation of brain tumors. Eur J Radiol 2005; 55:393-400. [PMID: 16129247 DOI: 10.1016/j.ejrad.2005.02.004] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2004] [Revised: 02/08/2005] [Accepted: 02/10/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine whether diffusion-weighted imaging by using minimum apparent diffusion coefficient (ADC(min)) values could differentiate various brain tumors including gliomas, metastases, and lymphomas. MATERIALS AND METHODS We examined 65 patients with histologically or clinically diagnosed brain tumors (12 low-grade gliomas, 31 high-grade gliomas, 14 metastatic tumors, and 8 lymphomas) using a 1.5 T MR unit. On diffusion-weighted imaging, the ADC(min) values were measured within the tumors and mean values were evaluated regarding statistical differences between groups. RESULTS The ADC(min) values of low-grade gliomas (1.09+/-0.20 x 10(-3)mm(2)/s) were significantly higher (p<.001) than those of other tumors. There were no statistical significant differences between glioblastomas (0.70+/-0.16 mm(2)/s), anaplastic astrocytomas (0.77+/-0.21 mm(2)/s), metastases (0.78+/-0.21 mm(2)/s), and lymphomas. But, lymphomas had lower mean ADC(min) values (0.54+/-0.10mm(2)/s) than high-grade gliomas and metastases. CONCLUSION The ADC measurements may help to differentiate low-grade gliomas from high-grade gliomas, metastases, and lymphomas. Although there is no statistical difference, lymphomas seem to have marked restriction in diffusion coefficients.
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Affiliation(s)
- Omer Kitis
- Department of Radiology, School of Medicine, Ege University, 35100 Bornova, Izmir, Turkey.
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41
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Steiner I, Budka H, Chaudhuri A, Koskiniemi M, Sainio K, Salonen O, Kennedy PGE. Viral encephalitis: a review of diagnostic methods and guidelines for management. Eur J Neurol 2005; 12:331-43. [PMID: 15804262 DOI: 10.1111/j.1468-1331.2005.01126.x] [Citation(s) in RCA: 156] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Viral encephalitis is a medical emergency. The spectrum of brain involvement and the prognosis are dependent mainly on the specific pathogen and the immunological state of the host. Although specific therapy is limited to only several viral agents, correct immediate diagnosis and introduction of symptomatic and specific therapy has a dramatic influence upon survival and reduces the extent of permanent brain injury in survivors. We searched MEDLINE (National Library of Medicine) for relevant literature from 1966 to May 2004. Review articles and book chapters were also included. Recommendations are based on this literature based on our judgment of the relevance of the references to the subject. Recommendations were reached by consensus. Where there was lack of evidence but consensus was clear we have stated our opinion as good practice points. Diagnosis should be based on medical history, examination followed by analysis of cerebrospinal fluid for protein and glucose contents, cellular analysis and identification of the pathogen by polymerase chain reaction (PCR) amplification (recommendation level A) and serology (recommendation level B). Neuroimaging, preferably by magnetic resonance imaging, is an essential aspect of evaluation (recommendation level B). Lumbar puncture can follow neuroimaging when immediately available, but if this cannot be obtained at the shortest span of time it should be delayed only in the presence of strict contraindications. Brain biopsy should be reserved only for unusual and diagnostically difficult cases. All encephalitis cases must be hospitalized with an access to intensive care units. Supportive therapy is an important basis of management. Specific, evidence-based, anti-viral therapy, acyclovir, is available for herpes encephalitis (recommendation level A). Acyclovir might also be effective for varicella-zoster virus encephalitis, gancyclovir and foscarnet for cytomegalovirus encephalitis and pleconaril for enterovirus encephalitis (IV class of evidence). Corticosteroids as an adjunct treatment for acute viral encephalitis are not generally considered to be effective and their use is controversial. Surgical decompression is indicated for impending uncal herniation or increased intracranial pressure refractory to medical management.
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Affiliation(s)
- I Steiner
- Laboratory of Neurovirology, Department of Neurology, Hadassah University Hospital, Jerusalem, Israel.
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42
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Pui MH, Wang Y. Diffusion and magnetization transfer MRI of brain infarct, infection, and tumor in children. Clin Imaging 2005; 29:162-71. [PMID: 15855060 DOI: 10.1016/j.clinimag.2004.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2004] [Revised: 07/20/2004] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to determine the efficacy of diffusion-weighted imaging (DWI) and magnetization transfer imaging (MTI) in the differential diagnosis of brain infarct, infection, hamartoma, and tumor in 106 children. The apparent diffusion coefficients (ADCs) and magnetization transfer ratios (MTRs) of the lesions were compared using nonparametric tests. There was an inverse relationship between ADC and MTR in subacute/chronic infarct, infection, hamartoma, arachnoid cyst, and tumor relative to normal brain parenchyma. Both ADC and MTR were reduced in acute infarct. DWI and MTI had a complementary role in the differential diagnosis of acute infarct from infection with lower MTR, from hamartoma with higher ADC, and from low-grade gliomas and benign tumors that had higher ADCs and lower MTRs. ADCs increased and MTRs decreased with the duration of infarct and lower tumor grade.
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Affiliation(s)
- Margaret H Pui
- Department of Radiology, McMaster University Medical Centre, Hamilton, Ontario, Canada L8N 3Z5.
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43
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Abstract
DTI seems to offer the possibility of adding important information to presurgical planning. Although experience is limited, DTI seems to provide useful local information about the structures near the tumor, and this seems to be useful in planning. In the future, DTI may provide an improved way to monitor intraoperative surgical procedures as well as their complications. Furthermore, evaluation of the response to treatment with chemotherapy and radiation therapy might also be possible. Although DTI has some limitations, its active investigation and further study are clearly warranted.
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Affiliation(s)
- L Celso Hygino Cruz Júnior
- Clínica de Diagnóstico por Imagem, Multi-Imagem Ressonância Magnética, Av. das Ameréricas 4666, Centro Médico Barrashopping, Rio de Janeiro, Brazil
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44
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Akasaka M, Sasaki M, Ehara S, Kamei A, Chida S. Transient decrease in cerebral white matter diffusivity on MR imaging in human herpes virus-6 encephalopathy. Brain Dev 2005; 27:30-3. [PMID: 15626538 DOI: 10.1016/j.braindev.2004.03.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2003] [Revised: 03/19/2004] [Accepted: 03/19/2004] [Indexed: 01/20/2023]
Abstract
We report a 16-month-old boy with human herpes virus-6 (HHV-6) encephalopathy showing transient abnormalities of the cerebral white matter on magnetic resonance imaging. Diffusion-weighted imaging (DWI) demonstrated diffuse high signal intensity in the bilateral cerebral white matter areas. The signal changes on DWI subsequently resolved, and cerebral atrophy resulted. The transient decrease in the cerebral white matter diffusivity seen in the present case may reflect axonal involvement secondary to the glial or neuronal damage in HHV-6 encephalopathy.
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Affiliation(s)
- Manami Akasaka
- Department of Pediatrics, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate 020-8505, Japan.
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45
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Abstract
Viruses probably account for most cases of acute meningitis. Viral meningitis is often assumed to be a largely benign disease. For the commonest pathogens causing meningitis, enteroviruses, this is usually the case; however, for many of the other pathogens causing viral meningitis, and for common pathogens in the immunocompromised or infants, viral meningitis is frequently associated with substantial neurological complications and a significant mortality. Diagnostic methods for rapid and accurate identification of pathogens have improved over recent years, permitting more precise and earlier diagnoses. There have been fewer developments in therapies for viral meningitis, and there remain no effective therapies for most pathogens, emphasising the importance of prevention and early diagnosis. This review focuses on the presentation, diagnosis and management of viral meningitis and also covers the prevention of meningitis for pathogens where effective vaccines are available.
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Affiliation(s)
- David R Chadwick
- Department of Infection & Travel Medicine, The James Cook University Hospital, Middlesbrough TS4 3BW, UK.
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46
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Abstract
OBJECTIVE This study was performed to evaluate the role of diffusion-weighted imaging (DWI) in the diagnosis of Japanese encephalitis (JE) and to look for any relationship of the apparent diffusion coefficient (ADC) values with duration of the illness. METHODS We performed DWI in fourteen patients of JE. T2 weighted (T2W) and DWI were compared for number and location of lesions in all patients. Based on imaging patients were divided in three groups: group 1 (n=9) showing more lesions on DWI compared with T2W images, group 2 (n=3) with equal number of lesions on T2W and DWI and group 3 (n=2) with lesions more pronounced on T2W than DWI. ADC values were computed for all the lesions. The time interval between onset of neurologic signs/symptoms and MRI were charted and correlated with ADC values. RESULTS DWI was helpful in making early diagnosis of JE by showing characteristic involvement of bilateral thalami in four patients. Nine out of fourteen patients showed additional lesions on DWI. ADC from lesions in groups I, II and III measured 0.648 +/- 0.099 x 10 mm/s, 0.739 +/- 0.166 x 10 mm/s and 1.123 +/- 0.185 x 10 mm/s respectively. The ADC from the lesions in group 1 was significantly lower compared with group 2 (P value <0.05) while it was higher in group 3 lesions compared with the other two groups. There was a significant direct correlation of ADC values with the disease duration in these cases (r=0.847, P <0.01). CONCLUSIONS DWI is helpful in early diagnosis and characterization of the duration of the lesions in JE.
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Affiliation(s)
- Mahesh Prakash
- Department of Radiodiagnosis, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow-226014, (U.P), India
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47
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Chang YW, Yoon HK, Shin HJ, Roh HG, Cho JM. MR imaging of glioblastoma in children: usefulness of diffusion/perfusion-weighted MRI and MR spectroscopy. Pediatr Radiol 2003; 33:836-42. [PMID: 14564423 DOI: 10.1007/s00247-003-0968-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2003] [Revised: 04/16/2003] [Accepted: 04/29/2003] [Indexed: 11/28/2022]
Abstract
BACKGROUND Glioblastoma is relatively uncommon in childhood and maybe difficult to differentiate from other brain tumors such as primitive neuroectodermal tumor, ependymoma, or benign astrocytoma. OBJECTIVE To describe the characteristic MR features in children with glioblastoma and to evaluate the usefulness of diffusion and perfusion MR imaging and MR spectroscopy in pediatric glioblastoma. MATERIALS AND METHODS MR imaging in 11 children (12 tumors) with biopsy-proven glioblastoma was reviewed retrospectively. In one patient, there was a recurrent glioblastoma. We reviewed CT and MRI imaging for tumor location, density/signal intensity, and enhancement pattern. Routine MR imaging was performed with a 1.5-T scanner. In six patients, diffusion-weighted MR images (DWIs) were obtained with a single-shot spin echo EPI technique with two gradient steps, and apparent diffusion coefficients (ADCs) were calculated. Using the gradient EPI technique, perfusion-weighted MR images (PWIs) were obtained in four patients from the data of dynamic MR images. The maximum relative cerebral blood volume (rCBV) ratio was calculated between the tumor and contralateral white matter in two cases. In three patients, proton MR spectroscopy was performed using a single voxel technique with either STEAM or PRESS sequences. The locations of the tumor were the thalamus and basal ganglia ( n=8), deep white matter ( n=3), and brain stem ( n=1). RESULTS Intratumoral hemorrhage was seen in four tumors. The tumors showed high-signal intensity or DWIs, having a wide range of ADC values of 0.53-1.30 (mean +/-SD=1.011+/-0.29). The maximum rCBV ratios of glioblastoma were 10.2 and 8.5 in two cases. MR spectroscopy showed decreased N-acetylaspartate (NAA) and increased choline in three cases. The MR findings of glioblastoma in children were: a diffusely infiltrative mass with hemorrhage involving the deep cerebral white matter, thalami, and basal ganglia. CONCLUSION Diffusion/perfusion MR imaging and MR spectroscopy are very helpful in diagnosing glioblastoma, determining the biopsy site, and evaluating tumor recurrence.
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Affiliation(s)
- Yun-Woo Chang
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Kangnam-gu, Seoul 135-710, Korea
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48
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Nouranifar RK, Ali M, Nath J. The earliest manifestation of focal encephalitis on diffusion-weighted MRI. Clin Imaging 2003; 27:316-20. [PMID: 12932681 DOI: 10.1016/s0899-7071(03)00003-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report the case of an adult patient with a focus of meningioencephalitis in whom the earliest magnetic resonance imaging (MRI) manifestation was hyperintense signal on diffusion-weighted (DW) sequence only. To our knowledge, this is the first adult encephalitis case to be reported with the MRI diffusion-weighted pulse sequence being the only positive MRI finding. A brief review of the pertinent literature is included.
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Affiliation(s)
- Rabin Katan Nouranifar
- Department of Radiology, SUNY Brooklyn Health Science Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
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49
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Jan W, Zimmerman RA, Wang ZJ, Berry GT, Kaplan PB, Kaye EM. MR diffusion imaging and MR spectroscopy of maple syrup urine disease during acute metabolic decompensation. Neuroradiology 2003; 45:393-9. [PMID: 12736767 DOI: 10.1007/s00234-003-0955-7] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2002] [Accepted: 12/30/2002] [Indexed: 12/13/2022]
Abstract
Maple syrup urine disease (MSUD) is an inborn error of amino acid metabolism, which affects the brain tissue resulting in impairment or death if untreated. Imaging studies have shown reversible brain edema during acute metabolic decompensation. The purpose of this paper is to describe the diffusion-weighted imaging (DWI) and spectroscopy findings during metabolic decompensation and to assess the value of these findings in the prediction of patient outcome. Six patients with the diagnosis of MSUD underwent conventional MR imaging with DWI during acute presentation with metabolic decompensation. Spectroscopy with long TE was performed in four of the six patients. Follow-up examinations were performed after clinical and metabolic recovery. DWI demonstrated marked restriction of proton diffusion compatible with cytotoxic or intramyelinic sheath edema in the brainstem, basal ganglia, thalami, cerebellar and periventricular white matter and the cerebral cortex. This was accompanied by the presence of an abnormal branched-chain amino acids (BCAA) and branched-chain alpha-keto acids (BCKA) peak at 0.9 ppm as well as elevated lactate on proton spectroscopy in all four patients. The changes in all six patients were reversed with treatment without evidence of volume loss or persistent tissue damage. The presence of cytotoxic or intramyelinic edema as evidenced by restricted water diffusion on DWI, with the presence of lactate on spectroscopy, could imply imminent cell death. However, in the context of metabolic decompensation in MSUD, it appears that changes in cell osmolarity and metabolism can reverse completely after metabolic correction.
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Affiliation(s)
- Wajanat Jan
- Department of Radiology, University of Pennsylvania School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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50
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Tsuchiya K, Osawa A, Katase S, Fujikawa A, Hachiya J, Aoki S. Diffusion-weighted MRI of subdural and epidural empyemas. Neuroradiology 2003; 45:220-3. [PMID: 12687304 DOI: 10.1007/s00234-003-0949-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2002] [Accepted: 12/18/2002] [Indexed: 10/20/2022]
Abstract
We reviewed diffusion-weighted images (DWI) from eight patients with subdural and four with epidural empyemas to assess the possibility of differentiating between these lesions by DWI. The signal intensities of the empyemas on DWI, and maps of the apparent diffusion coefficient (ADC) were analysed in seven patients. In seven of the eight patients with subdural empyema, the lesions appeared as areas of high signal. The ADC maps confirmed that these areas were the result of restricted diffusion. (In the remaining patient, the lesion showed a mixture of high and low signal.) The epidural empyemas contained areas of low signal in all four patients; part of the empyema was isointense or gave high signal in two. DWI may be an adjunct to conventional sequences for differentiating between subdural and epidural empyemas.
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Affiliation(s)
- K Tsuchiya
- Department of Radiology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, 181-8611, Tokyo, Japan.
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