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Galanaud D, Gupta R. MR Imaging for Acute Central Nervous System Pathologies and Presentations in Emergency Department. Magn Reson Imaging Clin N Am 2022; 30:371-381. [PMID: 35995468 DOI: 10.1016/j.mric.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Although evaluation of suspected stroke is a major driver of MRI use in the emergency department (ED), the exquisite contrast resolution and flexibility provided by MRI are valuable in the workup of a broad variety of acute neurologic complaints. This article provides an overview, focused primarily on "non-stroke" neurologic emergencies encountered in ED brain MRI that emergency radiologists should be familiar with.
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Affiliation(s)
- Damien Galanaud
- Department of Neuroradiology, Pitié Salpêtrière Hospital, 47 Boulevard de l'hopital, Paris 75013, France
| | - Rajiv Gupta
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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2
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Reyntiens P, Bossche SV, Loos C, Dekeyzer S. Two cases of symptomatic developmental venous anomalies: imaging findings and possible etiology. Acta Neurol Belg 2022; 122:1089-1092. [PMID: 35476293 DOI: 10.1007/s13760-022-01905-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/17/2022] [Indexed: 12/01/2022]
Affiliation(s)
- P Reyntiens
- Department of Radiology, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - S Vanden Bossche
- Department of Radiology, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - C Loos
- Department of Neurology, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650, Edegem, Belgium
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - S Dekeyzer
- Department of Radiology, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650, Edegem, Belgium.
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3
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Chung J, Lee JY, Kim YS. Serial brain magnetic resonance imaging in a patient with invasive streptococcal infection with ventriculitis and choroid plexitis. JOURNAL OF NEUROCRITICAL CARE 2021. [DOI: 10.18700/jnc.210026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Luque-Paz D, Revest M, Eugène F, Boukthir S, Dejoies L, Tattevin P, Le Reste PJ. Ventriculitis: A Severe Complication of Central Nervous System Infections. Open Forum Infect Dis 2021; 8:ofab216. [PMID: 34095339 PMCID: PMC8176394 DOI: 10.1093/ofid/ofab216] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ventriculitis, a dreaded complication of brain abscess, meningitis, and various neurosurgical procedures, has attracted limited attention in the medical literature. METHODS This is a retrospective, single-center study. We screened the medical files of all patients who had a brain imaging report that included the word "ventriculitis" during years 2005-2019. Only patients with clinical, microbiological, and imaging features of ventriculitis were included. Data were collected through a standardized questionnaire. RESULTS Ninety-eight patients fulfilled inclusion criteria: 42 women and 56 men, and the median age was 60 years (interquartile range, 48-68). The primary mechanism for ventriculitis was classified as follows: brain abscess (n = 29, 29.6%), meningitis (n = 27, 27.6%), intraventricular catheter-related (n = 17, 17.3%), post-neurosurgery (n = 13, 13.3%), and hematogenous (n = 12, 12.2%). The main neuroimaging features were intraventricular pus (n = 81, 82.7%), ependymal enhancement (n = 70, 71.4%), and intraventricular loculations (n = 15, 15.3%). The main pathogens were streptococci (n = 44, 44.9%), Gram-negative bacilli (n = 27, 27.6%), and staphylococci (n = 15, 15.3%). In-hospital and 1-year mortality rates were 30.6% (n = 30) and 38.8% (n = 38), respectively. Neurological sequelae were reported in 34 of 55 (61.8%) survivors, including cognitive impairment (n = 11), gait disturbances (n = 9), paresis (n = 7), behavior disorder (n = 6), and epilepsy (n = 5). On multivariate analysis, age >65 years, Glasgow Coma Scale score <13 at initial presentation, status epilepticus, hydrocephalus, and positive cerebrospinal fluid culture were associated with 1-year mortality. We built a scoring system to stratify patients with ventriculitis into low risk (12.5%), intermediate risk (36.5%), and high risk (71.4%) of death. CONCLUSIONS Ventriculitis is a severe complication of brain abscess, meningitis, or neurosurgery, with an in-hospital mortality rate of 30% and neurological sequelae in 60% of survivors.
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Affiliation(s)
- David Luque-Paz
- Infectious Diseases and Intensive Care Unit, Rennes University Hospital, Rennes, France
- Rennes University, Inserm, Bacterial Regulatory RNAs and Medicine, UMR_S 1230, Rennes, France
| | - Matthieu Revest
- Infectious Diseases and Intensive Care Unit, Rennes University Hospital, Rennes, France
- Rennes University, Inserm, Bacterial Regulatory RNAs and Medicine, UMR_S 1230, Rennes, France
- CIC-Inserm 1414, Rennes University Hospital, Rennes, France
| | - François Eugène
- Department of Neuroradiology, Rennes University Hospital, Rennes, France
| | - Sarrah Boukthir
- Bacteriology Department, Rennes University Hospital, Rennes, France
| | - Loren Dejoies
- Bacteriology Department, Rennes University Hospital, Rennes, France
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Rennes University Hospital, Rennes, France
- Rennes University, Inserm, Bacterial Regulatory RNAs and Medicine, UMR_S 1230, Rennes, France
- CIC-Inserm 1414, Rennes University Hospital, Rennes, France
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5
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Abstract
Acute intracranial infections of the central nervous system and skull base are uncommon but time sensitive diagnoses that may present to the emergency department. As symptoms are frequently nonspecific or lack typical features of an infectious process, a high index of suspicion is required to confidently make the diagnosis, and imaging may not only serve as the first clue to an intracranial infection, but is often necessary to completely characterize the disease process and exclude any confounding conditions. Although computed tomography is typically the initial imaging modality for many of these patients, magnetic resonance imaging offers greater sensitivity and specificity in diagnosing intracranial infections, characterizing the full extent of infection, and identifying potential complications. The aim of this article is to serve as a review of the typical and most important imaging manifestations of these infections that can be encountered in the emergent setting.
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Kurihara M, Nasu M, Itokazu D, Tokuda Y. Kushiyaki-related Streptococcus suis meningitis with ventriculitis: A case report. Clin Case Rep 2021; 9:e04108. [PMID: 34026150 PMCID: PMC8133079 DOI: 10.1002/ccr3.4108] [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: 02/10/2021] [Revised: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 11/26/2022] Open
Abstract
Streptococcus suis causes a zoonotic disease that commonly manifests as meningitis. People handle pork or its derivatives are at a high risk of infection. Handwashing and donning personal protective equipment are the practical preventive measures.
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Affiliation(s)
- Masaru Kurihara
- Department of Hospital MedicineUrasoe General HospitalOkinawaJapan
| | - Michitaka Nasu
- Department of Emergency and Critical Care MedicineUrasoe General HospitalOkinawaJapan
| | - David Itokazu
- Okinawa Asia Clinical Investigation SynergyOkinawaJapan
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Pota V, Passavanti MB, Coppolino F, Di Zazzo F, De Nardis L, Esposito R, Fiore M, Mangoni di Santostefano GSRC, Aurilio C, Sansone P, Pace MC. Septic shock due to Escherichia coli meningoencephalitis treated with immunoglobulin-M-enriched immunoglobulin preparation as adjuvant therapy: a case report. J Med Case Rep 2021; 15:138. [PMID: 33775244 PMCID: PMC8005330 DOI: 10.1186/s13256-021-02731-7] [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: 08/07/2019] [Accepted: 02/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gram-negative bacteria are an uncommon etiology of spontaneous community-acquired adult meningitis and meningoencephalitis. Escherichia coli is a Gram-negative bacterium that is normally present in the intestinal microbial pool. Some Escherichia coli strains can cause diseases in humans and animals, with both intestinal and extraintestinal manifestations (extraintestinal pathogenic Escherichia coli) such as urinary tract infections, bacteremia with sepsis, and, more rarely, meningitis. Meningitis continues to be an important cause of mortality throughout the world, despite progress in antimicrobial chemotherapy and supportive therapy. The mortality rate fluctuates between 15% and 40%, and about 50% of the survivors report neurological sequelae. The majority of Escherichia coli meningitis cases develop as a result of hematogenous spread, with higher degrees of bacteremia also being related to worse prognosis. Cases presenting with impaired consciousness (that is, coma) are also reported to have poorer outcomes. CASE PRESENTATION We describe the case of a 48-year-old caucasian woman with meningoencephalitis, with a marked alteration of consciousness on admission, and septic shock secondary to pyelonephritis caused by Escherichia coli, treated with targeted antimicrobial therapy and immunoglobulin-M-enriched immunoglobulin (Pentaglobin) preparation as adjuvant therapy. CONCLUSION Despite the dramatic presentation of the patient on admission, the conflicting data on the use of immunoglobulins in septic shock, and the lack of evidence regarding their use in adult Escherichia coli meningoencephalitis, we obtained a remarkable improvement of her clinical condition, accompanied by partial resolution of her neurological deficits.
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Affiliation(s)
- V Pota
- Dept of Women, Child, General and Specialist Surgery, University of Campania "L. Vanvitelli", Naples, Italy.
| | - M B Passavanti
- Dept of Women, Child, General and Specialist Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - F Coppolino
- Dept of Women, Child, General and Specialist Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - F Di Zazzo
- Dept of Women, Child, General and Specialist Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - L De Nardis
- Dept of Women, Child, General and Specialist Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - R Esposito
- Dept of Women, Child, General and Specialist Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - M Fiore
- Dept of Women, Child, General and Specialist Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | | | - C Aurilio
- Dept of Women, Child, General and Specialist Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - P Sansone
- Dept of Women, Child, General and Specialist Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - M C Pace
- Dept of Women, Child, General and Specialist Surgery, University of Campania "L. Vanvitelli", Naples, Italy
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8
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Farrell TP, Adams NC, Looby S. Neuroimaging of central diabetes insipidus. HANDBOOK OF CLINICAL NEUROLOGY 2021; 181:207-237. [PMID: 34238459 DOI: 10.1016/b978-0-12-820683-6.00016-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Central diabetes insipidus (CDI) occurs secondary to deficient synthesis or secretion of arginine vasopressin peptide from the hypothalamo-neurohypophyseal system (HNS). It is characterized by polydipsia and polyuria (urine output >30mL/kg/day in adults and >2l/m2/24h in children) of dilute urine (<250mOsm/L). It can result from any pathology affecting one or more components of the HNS including the hypothalamic osmoreceptors, supraoptic or paraventricular nuclei, and median eminence of the hypothalamus, infundibulum, stalk or the posterior pituitary gland. MRI is the imaging modality of choice for evaluation of the hypothalamic-pituitary axis (HPA), and a dedicated pituitary or sella protocol is essential. CT can provide complimentary diagnostic information and is also of value when MRI is contraindicated. The most common causes are benign or malignant neoplasia of the HPA (25%), surgery (20%), and head trauma (16%). No cause is identified in up to 30% of cases, classified as idiopathic CDI. Knowledge of the anatomy and physiology of the HNS is crucial when evaluating a patient with CDI. Establishing the etiology of CDI with MRI in combination with clinical and biochemical assessment facilitates appropriate targeted treatment. This chapter illustrates the wide variety of causes and imaging correlates of CDI on neuroimaging, discusses the optimal imaging protocols, and revises the detailed neuroanatomy required to interpret these studies.
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Affiliation(s)
- Terence Patrick Farrell
- Division of Neuroradiology, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | - Niamh Catherine Adams
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
| | - Seamus Looby
- Department of Neuroradiology, Beaumont Hospital, Dublin, Ireland
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9
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Li S, Nguyen IP, Urbanczyk K. Common infectious diseases of the central nervous system-clinical features and imaging characteristics. Quant Imaging Med Surg 2020; 10:2227-2259. [PMID: 33269224 DOI: 10.21037/qims-20-886] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Shan Li
- Department of Radiology, Baystate Medical Center, University of Massachusetts School of Medicine-Baystate, Springfield, MA, USA
| | - Ivy P Nguyen
- Department of Radiology, Baystate Medical Center, University of Massachusetts School of Medicine-Baystate, Springfield, MA, USA
| | - Kyle Urbanczyk
- Department of Radiology, Baystate Medical Center, University of Massachusetts School of Medicine-Baystate, Springfield, MA, USA
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10
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Suzuki Y, Kawakami S, Yamada M, Sohmiya M, Shibuya K, Maeda N. Clinical effects of polymyxin B-immobilized fiber column direct hemoperfusion for severe bacterial meningitis: A series of 10 cases. Clin Case Rep 2020; 8:823-832. [PMID: 32477526 PMCID: PMC7250985 DOI: 10.1002/ccr3.2756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 12/26/2022] Open
Abstract
Our results suggest a possible role for Polymyxin B-immobilized fiber column direct hemoperfusion in combination with standard therapy in the rapid improvement of impaired consciousness in patients with severe bacterial meningitis.
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Affiliation(s)
- Yoko Suzuki
- Department of NeurologyOmori Red Cross HospitalTokyoJapan
| | | | - Minako Yamada
- Department of NeurologyOmori Red Cross HospitalTokyoJapan
| | - Makoto Sohmiya
- Graduate School of Health SciencesGunma Paz UniversityTakasakiJapan
| | - Ken Shibuya
- Department of NephrologyOmori Red Cross HospitalTokyoJapan
| | - Nobuya Maeda
- Department of NeurologyOmori Red Cross HospitalTokyoJapan
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11
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Nguyen I, Urbanczyk K, Mtui E, Li S. Intracranial CNS Infections: A Literature Review and Radiology Case Studies. Semin Ultrasound CT MR 2020; 41:106-120. [DOI: 10.1053/j.sult.2019.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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12
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Gadde JA, Weinberg BD, Mullins ME. Neuroimaging of Patients in the Intensive Care Unit: Pearls and Pitfalls. Radiol Clin North Am 2019; 58:167-185. [PMID: 31731899 DOI: 10.1016/j.rcl.2019.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A brief introduction is provided of the different imaging modalities encountered in the intensive care unit (ICU). The spectrum of intracranial pathology as well as potential postsurgical complications is reviewed, with a focus on pearls and pitfalls. A brief overview also is provided of imaging of the spine in an ICU patient.
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Affiliation(s)
- Judith A Gadde
- Department of Radiology and Imaging Services, Emory University School of Medicine, 1364 Clifton Road Northeast, Suite BG20, Atlanta, GA 30319, USA.
| | - Brent D Weinberg
- Department of Radiology and Imaging Services, Emory University School of Medicine, 1364 Clifton Road Northeast, Suite BG20, Atlanta, GA 30319, USA
| | - Mark E Mullins
- Department of Radiology and Imaging Services, Emory University School of Medicine, 1364 Clifton Road Northeast, Suite BG20, Atlanta, GA 30319, USA
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13
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Mackay CJ, Chen Y. Ruptured cerebral abscess with ventriculitis and leptomeningitis; A rare complication in the setting of metastatic esophageal cancer: Case report and literature review. Radiol Case Rep 2019; 14:782-785. [PMID: 31011379 PMCID: PMC6461570 DOI: 10.1016/j.radcr.2019.03.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 02/05/2023] Open
Abstract
Esophageal cancer is one of the deadliest cancers worldwide, and metastatic esophageal carcinoma carries a very poor prognosis. Patients tend to decline rapidly, with an overall 5-year survival rate less than 20%. Furthermore, understanding the eventual cause of death in patients with esophageal cancer may serve to guide treatment and hopefully improve the patient's quality of life. Less common causes of death in patients with metastatic esophageal cancer have infrequently been described in the literature. Our report outlines a unique case of metastatic esophageal carcinoma, complicated by ruptured intracranial abscess, with subsequent ventriculitis and leptomeningitis.
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Affiliation(s)
- Chad J. Mackay
- St. Joseph's Hospital, Department of Radiology, Medical College of Wisconsin, Affiliated Hospitals, 5000 W. Chambers Street, Milwaukee, WI 53210, USA
| | - Yao Chen
- Milwaukee Radiologists Limited, Milwaukee, WI
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14
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Tokimura R, Iguchi M, Ito E, Murakami T, Ugawa Y. [The duration of antibiotic therapy in bacterial meningitis with pyogenic ventriculitis]. Rinsho Shinkeigaku 2019; 59:133-138. [PMID: 30814444 DOI: 10.5692/clinicalneurol.cn-001210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 68-year-old man visited our hospital emergency department with consciousness disturbance. He was diagnosed as bacterial meningitis with septic shock, and initial empirical antibacterial therapy was initiated immediately. Streptococcus pneumoniae. was cultured from the cerebrospinal fluid (CSF), and brain MRIs showed pyogenic ventriculitis. Even though CSF findings improved, he was still in coma and finally died with pneumonia. It is unknown how pyogenic ventriculitis affects the course of bacterial meningitis. We analyzed total 11 inpatients with bacterial meningitis associated with or without the pyogenic ventriculitis, including the present patient, in our hospital. Severity of clinical symptoms and CSF findings might determine the duration of antimicrobial administration, regardless of whether pyogenic ventriculitis existed or not.
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Affiliation(s)
- Ryo Tokimura
- Department of Neurology, Fukushima Medical University
| | | | - Eiich Ito
- Department of Neurology, Fukushima National Hospital
| | | | - Yoshikazu Ugawa
- Department of Neuro-regeneration, Fukushima Medical University
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15
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Mahammedi A, Bachir S, Purdy J, Larvie M, Buehler M. Pyogenic brain abscess, ventriculitis and diffuse meningitis with fatal outcome in an adult: Radiologic-pathologic correlation ☆,. Radiol Case Rep 2018; 13:1063-1068. [PMID: 30228844 PMCID: PMC6137902 DOI: 10.1016/j.radcr.2018.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/13/2018] [Accepted: 04/13/2018] [Indexed: 10/25/2022] Open
Abstract
Rupture of brain abscesses with evolution into ventriculitis with meningitis may result in sudden and dramatic worsening of the clinical situation. We present a 57-year-old man with such an event and fatal outcome. Multiple imaging modalities including computed tomography and advanced magnetic resonance imaging were correlated with gross specimen and histologic images. The differential diagnosis of multiple lesions with ring enhancement and prominent perifocal edema includes mainly infectious and neoplastic processes, such as brain abscess, metastasis, and multicentric glioblastoma. Pyogenic ventriculitis is an uncommon manifestation of severe intracranial infection that might be clinically obscure. We discuss the characteristic magnetic resonance findings of brain abscess and its complications, including meningitis and ventriculitis with emphasis on the role of diffusion-weighted and fluid-attenuated inversion recovery imaging.
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Affiliation(s)
- Abdelkader Mahammedi
- Cleveland Clinic, Department of Neuroradiology, Neuroradiology Room L10-407, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Suha Bachir
- Cleveland Clinic, Department of Neuroradiology, Neuroradiology Room L10-407, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Jenna Purdy
- University of Toledo, Department of Pathology and Neuroradiology, Toledo, OH, USA
| | - Mykol Larvie
- Cleveland Clinic, Department of Neuroradiology, Neuroradiology Room L10-407, 9500 Euclid Ave., Cleveland, OH 44195, USA
| | - Mark Buehler
- University of Toledo, Department of Pathology and Neuroradiology, Toledo, OH, USA
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16
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SyMRI of the Brain: Rapid Quantification of Relaxation Rates and Proton Density, With Synthetic MRI, Automatic Brain Segmentation, and Myelin Measurement. Invest Radiol 2018; 52:647-657. [PMID: 28257339 PMCID: PMC5596834 DOI: 10.1097/rli.0000000000000365] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Conventional magnetic resonance images are usually evaluated using the image signal contrast between tissues and not based on their absolute signal intensities. Quantification of tissue parameters, such as relaxation rates and proton density, would provide an absolute scale; however, these methods have mainly been performed in a research setting. The development of rapid quantification, with scan times in the order of 6 minutes for full head coverage, has provided the prerequisites for clinical use. The aim of this review article was to introduce a specific quantification method and synthesis of contrast-weighted images based on the acquired absolute values, and to present automatic segmentation of brain tissues and measurement of myelin based on the quantitative values, along with application of these techniques to various brain diseases. The entire technique is referred to as “SyMRI” in this review. SyMRI has shown promising results in previous studies when used for multiple sclerosis, brain metastases, Sturge-Weber syndrome, idiopathic normal pressure hydrocephalus, meningitis, and postmortem imaging.
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17
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Saberi A, Roudbary SA, Ghayeghran A, Kazemi S, Hosseininezhad M. Diagnosis of Meningitis Caused by Pathogenic Microorganisms Using Magnetic Resonance Imaging: A Systematic Review. Basic Clin Neurosci 2018; 9:73-86. [PMID: 29967667 PMCID: PMC6026091 DOI: 10.29252/nirp.bcn.9.2.73] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Introduction: Bacterial meningitis is an acute infectious inflammation of the protective membranes covering the brain. Its early diagnosis is vital because of its high morbidity and mortality. It is mostly diagnosed by a gold standard diagnostic tool i.e. Cerebrospinal Fluid (CSF) analysis. However, it is sometimes difficult and or impossible to do this procedure and an alternative diagnostic tool is needed. Contrast enhanced magnetic resonance imaging can detect the pus or other changes in subarachnoid space. But our optimal aim is to use an imaging method without using contrast to be useable and available in more specific condition. Methods: This study aimed to survey the role of non-contrast Magnetic Resonance Imaging (MRI) in the diagnosis of the bacterial meningitis. MEDLINE/PubMed Central, Web of Science and Scopus were searched without time period and language limitation until March 2017. We found 6410 papers in our initial search. After assessing the content of the papers based on Cochrane library guidelines and inclusion/exclusion criteria, 6 relevant studies were included in the systematic review. All of included studies were observational studies. Results: MRI studies demonstrated that Fluid Attenuation Inversion Recovery (FLAIR) and Diffusion-Weighted Image (DWI) MR imaging among all MRI modalities can detect some abnormalities compatible with bacterial meningitis. FLAIR and DWI-MR imaging are potentially useful to diagnose bacterial meningitis and can be used in emergent condition in which bacterial meningitis is highly suspicious and the other diagnostic tools are not available or feasible.
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Affiliation(s)
- Alia Saberi
- Neurosciences Research Center, Department of Neurology, Pouursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Seyed-Ali Roudbary
- Department of Neurology, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Amirreza Ghayeghran
- Department of Neurology, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Samaneh Kazemi
- Deputy of Research and Technology, Guilan University of Medical Sciences, Rasht, Iran
| | - Mozaffar Hosseininezhad
- Department of Neurology, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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18
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Yanase T, Morii D, Kamio S, Nishimura A, Fukao E, Inose Y, Honma Y, Kitahara N, Yokozawa T, Chang B, Oda T. The first report of human meningitis and pyogenic ventriculitis caused by Streptococcus suis: A case report. J Infect Chemother 2018; 24:669-673. [PMID: 29429850 DOI: 10.1016/j.jiac.2018.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 01/15/2018] [Indexed: 10/18/2022]
Abstract
Streptococcus suis, a gram-positive facultative anaerobe commonly found in pigs, is an emerging zoonotic pathogen. Herein, we describe a case of a 45-year-old male Japanese meat wholesaler with S. suis meningitis and pyogenic ventriculitis. S. suis was isolated from his blood and cerebrospinal fluid culture, and sequence type (ST) and serotype were confirmed to be ST1 and serotype 2, respectively, by multilocus sequence typing and the Quellung reaction. Magnetic resonance imaging (MRI) revealed right labyrinthitis and pyogenic ventriculitis. The patient was treated with ceftriaxone and ampicillin for 24 days; the treatment was deemed successful based on negative blood cultures on day 4. However, the patient experienced hearing loss and a vestibular nerve disorder. S. suis is a rare pathogen in Japan but can cause severe infection and sequelae. To the best of our knowledge, this is the first report of a human case of pyogenic ventriculitis caused by S. suis. Our findings suggest that S. suis infection should be considered when hearing impairment is present in a patient with bacterial infection and that MRI can help detect ventriculitis, which can necessitate a prolonged treatment duration.
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Affiliation(s)
- Tomonobu Yanase
- Department of Infectious Disease, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo 187-8510, Japan.
| | - Daiichi Morii
- Department of Infectious Disease, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo 187-8510, Japan; Department of Infectious Control and Prevention, Graduate School of Medicine, Osaka University, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Satoshi Kamio
- Department of Neurology, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo 187-8510, Japan
| | - Ayako Nishimura
- Department of Neurology, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo 187-8510, Japan
| | - Eri Fukao
- Department of Neurology, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo 187-8510, Japan
| | - Yuri Inose
- Department of Neurology, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo 187-8510, Japan
| | - Yutaka Honma
- Department of Neurology, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo 187-8510, Japan
| | - Nobuo Kitahara
- Department of Otorhinolaryngology, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo 187-8510, Japan
| | - Takayuki Yokozawa
- Department of Clinical Laboratory, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo 187-8510, Japan
| | - Bin Chang
- Department of Bacteriology I, National Institute of Infectious Diseases, 1-23-1Toyama, Shinjuku, Tokyo 162-8640, Japan
| | - Toshimi Oda
- Department of Infectious Disease, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo 187-8510, Japan
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Rozell JM, Mtui E, Pan YN, Li S. Infectious and inflammatory diseases of the central nervous system-the spectrum of imaging findings and differential diagnosis. Emerg Radiol 2017; 24:619-633. [PMID: 28831608 DOI: 10.1007/s10140-017-1543-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/03/2017] [Indexed: 12/30/2022]
Abstract
The infectious and inflammatory diseases of the central nervous system (CNS) including the brain and spine can present with a wide spectrum of clinical symptoms, locations, and appearance. The purpose of this exhibit is to review the different patterns of their presentations, to illustrate their imaging characteristics and techniques, and to discuss their clinical features and pathology so that the correct diagnosis can be made and prompt intervention can be initiated on a timely fashion.
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Affiliation(s)
- Joseph M Rozell
- Department of Radiology, Baystate Medical Center, University of Massachusetts School of Medicine, Springfield Campus, 759 Chestnut Street, Springfield, MA, 01199, USA
| | - Edward Mtui
- Department of Radiology, Baystate Medical Center, University of Massachusetts School of Medicine, Springfield Campus, 759 Chestnut Street, Springfield, MA, 01199, USA
| | - Yu-Ning Pan
- Department of Radiology, Ningbo First Hospital, Zhejiang University, 59 Liuting Road, Haishu District, Ningbo, 315010, Zhejiang, China
| | - Shan Li
- Department of Radiology, Baystate Medical Center, University of Massachusetts School of Medicine, Springfield Campus, 759 Chestnut Street, Springfield, MA, 01199, USA.
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20
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A Rare Central Nervous System Fungal Infection Resulting from Brown Heroin Use. J Emerg Med 2017; 52:314-317. [DOI: 10.1016/j.jemermed.2016.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/30/2016] [Accepted: 09/05/2016] [Indexed: 01/05/2023]
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Elfiky N, Baldwin K. Brown Heroin-Associated Candida albicans Ventriculitis and Endophthalmitis Treated with Voriconazole. Case Rep Neurol 2016; 8:151-5. [PMID: 27504092 PMCID: PMC4965527 DOI: 10.1159/000447120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 05/25/2016] [Indexed: 11/19/2022] Open
Abstract
Chronic meningitis and ventriculitis are defined as inflammatory pleocytoses in the cerebrospinal fluid (CSF) and ependyma that persists for at least 1 month without spontaneous resolution. Because the CSF communicates directly with the posterior compartments of the eye, fungal infections in the brain often cause secondary ophthalmologic complications. We report a 23-year-old male who presented to the emergency room with progressive severe headaches associated with insidious monocular vision loss. After extensive workup and a multidisciplinary team effort, the patient was diagnosed with ventriculitis and endogenous endopthalmitis. The etiology is suspected to be due to brown heroin use with secondary disseminated Candida albicans.
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Affiliation(s)
- Nora Elfiky
- Geisinger Medical Center, Department of Neurology, Danville, Pa., USA
| | - Kelly Baldwin
- Geisinger Medical Center, Department of Neurology, Danville, Pa., USA
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Nakahara H, Oda T, Fukao E, Horiuchi I, Honma Y, Uchigata M. A case of meningococcal meningitis that was difficult to treat owing to concurrent ventriculitis. Rinsho Shinkeigaku 2016; 56:344-7. [PMID: 27151225 DOI: 10.5692/clinicalneurol.cn-000831] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 64-year-old male came to our hospital emergency department with fever and consciousness disturbance. Culture tests of blood and spinal fluid samples revealed meningococci (Neisseria meningitidis), and we made a diagnosis of meningococcal meningitis. Brain magnetic resonance imaging (MRI) findings revealed ventriculitis. Ceftriaxone was administered for 17 days, however, relapse was noted after that was discontinued, with neutropenia and renal impairment thought to be adverse reactions to the beta-lactam antibiotic. Hence, treatment was switched to oral administration of moxifloxacin for a total of 12 weeks, including in an outpatient setting. After moxifloxacin was discontinued, no side effects or relapse were seen, and treatment was ended. Although antibacterial agents generally show favorable effects for meningococcal meningitis, we consider that sufficient antimicrobial therapy is difficult in cases complicated with ventriculitis.
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