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Role of advanced MRI brain sequences in diagnosing neurological complications of scrub typhus.

Sood S, Sharma S, Khanna S - J Clin Imaging Sci (2015)

Bottom Line: Scrub typhus is a rare disease affecting many organs and causing vasculitis by affecting the endothelium of blood vessels.Review of literature shows that there are only a few case reports describing the neuroradiological manifestations of scrub typhus.This case report describes how newer and advanced MRI sequences are able to diagnose neurological complications of scrub typhus, such as hemorrhages, meningoencephalitis, infarctions, cranial nerve involvement, thrombosis, and hypoperfusion, that are not picked up on routine magnetic resonance imaging (MRI) sequences.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiodiagnosis and Imaging, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.

ABSTRACT
Scrub typhus is a rare disease affecting many organs and causing vasculitis by affecting the endothelium of blood vessels. Review of literature shows that there are only a few case reports describing the neuroradiological manifestations of scrub typhus. This case report describes how newer and advanced MRI sequences are able to diagnose neurological complications of scrub typhus, such as hemorrhages, meningoencephalitis, infarctions, cranial nerve involvement, thrombosis, and hypoperfusion, that are not picked up on routine magnetic resonance imaging (MRI) sequences.

No MeSH data available.


Related in: MedlinePlus

18-year-old adult female who presented to the emergency department in an unconscious state with fever and rash was diagnosed with scrub typhus. (a and b) SWI images of MRI brain show multiple petechial hemorrages in the splenium and body of corpus callosum (white arrows in 2a) and in the subcortical white matter (white arrows in 2b). (c) Post-contrast MP RAGE axial image shows enhancement of pachymeninges along the frontal lobe bilaterally (white arrows).
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Figure 2: 18-year-old adult female who presented to the emergency department in an unconscious state with fever and rash was diagnosed with scrub typhus. (a and b) SWI images of MRI brain show multiple petechial hemorrages in the splenium and body of corpus callosum (white arrows in 2a) and in the subcortical white matter (white arrows in 2b). (c) Post-contrast MP RAGE axial image shows enhancement of pachymeninges along the frontal lobe bilaterally (white arrows).

Mentions: An 18-year-old female presented to the emergency department in an unconscious state. She had developed fever and rash 3 days earlier. On examination, the patient was unconscious, febrile, had maculopapular rash throughout her body, and an eschar was noted on the right side of the pubic region [Figure 1]. Based on the clinical diagnosis of scrub typhus, MRI brain was done immediately. Scan revealed micro-hemorrhages in the body and splenium of corpus callosum, as well as in the sub-cortical white matter in bilateral centrum semiovale region [Figure 2a and b]. There was no mass effect or perilesional edema. These petechial hemorrhages were appreciated only in the susceptibility-weighted minimum intensity projection images. In post-contrast magnetization prepared rapid acquisition gradient recall echo (MP RAGE) sequence, there was enhancement of the pachymeninges along bilateral frontotemporoparietal lobes [Figure 2c]. Rest of the brain parenchyma was normal. No restriction was visualized on diffusion-weighted (DW) and apparent diffusion coefficient (ADC) sequences and there was no altered signal intensity on T2 and fluid-attenuated inversion recovery (FLAIR) sequences [Figure 3]. Time of flight (TOF) MRI angiography revealed normal vessels of circle of Willis. Arterial spin labeling (ASL) perfusion showed normal cerebral blood flow. A diagnosis of scrub typhus was made with the radiological findings identifying the pathology of vasculitis and meningitis.


Role of advanced MRI brain sequences in diagnosing neurological complications of scrub typhus.

Sood S, Sharma S, Khanna S - J Clin Imaging Sci (2015)

18-year-old adult female who presented to the emergency department in an unconscious state with fever and rash was diagnosed with scrub typhus. (a and b) SWI images of MRI brain show multiple petechial hemorrages in the splenium and body of corpus callosum (white arrows in 2a) and in the subcortical white matter (white arrows in 2b). (c) Post-contrast MP RAGE axial image shows enhancement of pachymeninges along the frontal lobe bilaterally (white arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4374194&req=5

Figure 2: 18-year-old adult female who presented to the emergency department in an unconscious state with fever and rash was diagnosed with scrub typhus. (a and b) SWI images of MRI brain show multiple petechial hemorrages in the splenium and body of corpus callosum (white arrows in 2a) and in the subcortical white matter (white arrows in 2b). (c) Post-contrast MP RAGE axial image shows enhancement of pachymeninges along the frontal lobe bilaterally (white arrows).
Mentions: An 18-year-old female presented to the emergency department in an unconscious state. She had developed fever and rash 3 days earlier. On examination, the patient was unconscious, febrile, had maculopapular rash throughout her body, and an eschar was noted on the right side of the pubic region [Figure 1]. Based on the clinical diagnosis of scrub typhus, MRI brain was done immediately. Scan revealed micro-hemorrhages in the body and splenium of corpus callosum, as well as in the sub-cortical white matter in bilateral centrum semiovale region [Figure 2a and b]. There was no mass effect or perilesional edema. These petechial hemorrhages were appreciated only in the susceptibility-weighted minimum intensity projection images. In post-contrast magnetization prepared rapid acquisition gradient recall echo (MP RAGE) sequence, there was enhancement of the pachymeninges along bilateral frontotemporoparietal lobes [Figure 2c]. Rest of the brain parenchyma was normal. No restriction was visualized on diffusion-weighted (DW) and apparent diffusion coefficient (ADC) sequences and there was no altered signal intensity on T2 and fluid-attenuated inversion recovery (FLAIR) sequences [Figure 3]. Time of flight (TOF) MRI angiography revealed normal vessels of circle of Willis. Arterial spin labeling (ASL) perfusion showed normal cerebral blood flow. A diagnosis of scrub typhus was made with the radiological findings identifying the pathology of vasculitis and meningitis.

Bottom Line: Scrub typhus is a rare disease affecting many organs and causing vasculitis by affecting the endothelium of blood vessels.Review of literature shows that there are only a few case reports describing the neuroradiological manifestations of scrub typhus.This case report describes how newer and advanced MRI sequences are able to diagnose neurological complications of scrub typhus, such as hemorrhages, meningoencephalitis, infarctions, cranial nerve involvement, thrombosis, and hypoperfusion, that are not picked up on routine magnetic resonance imaging (MRI) sequences.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiodiagnosis and Imaging, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.

ABSTRACT
Scrub typhus is a rare disease affecting many organs and causing vasculitis by affecting the endothelium of blood vessels. Review of literature shows that there are only a few case reports describing the neuroradiological manifestations of scrub typhus. This case report describes how newer and advanced MRI sequences are able to diagnose neurological complications of scrub typhus, such as hemorrhages, meningoencephalitis, infarctions, cranial nerve involvement, thrombosis, and hypoperfusion, that are not picked up on routine magnetic resonance imaging (MRI) sequences.

No MeSH data available.


Related in: MedlinePlus