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Leptomeningeal contrast enhancement and blood-CSF barrier dysfunction in aseptic meningitis.

Alonso A, Eisele P, Ebert AD, Griebe M, Engelhardt B, Szabo K, Hennerici MG, Gass A - Neurol Neuroimmunol Neuroinflamm (2015)

Bottom Line: The Qalb as a marker for the leakiness of the BCSFB and, more indirectly, of the blood-brain barrier (BBB) was positively correlated with the incidence of leptomeningeal contrast enhancement seen on postcontrast fluid-attenuated inversion recovery (FLAIR) MRI (p = 0.003).Patients with a more pronounced brain barrier dysfunction recovered more slowly and stayed longer in the hospital.The severity of meningeal BBB disturbance can be estimated on postcontrast FLAIR MRI, which may be of diagnostic value in patients with aseptic meningitis.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology (A.A., P.E., A.D.E., M.G., K.S., M.G.H., A.G.), Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany; and Theodor Kocher Institute (B.E.), University of Bern, Bern, Switzerland.

ABSTRACT

Objective: To investigate the blood-CSF barrier (BCSFB) dysfunction in aseptic meningitis.

Methods: In our case series of 14 patients with acute aseptic meningitis, we compared MRI characteristics with CSF findings.

Results: Contrast enhancement in the sulcal space in a leptomeningeal pattern was visualized in 7 patients with BCSFB dysfunction categorized as moderate to severe as evidenced by the CSF/serum albumin ratio (Qalb) but was not present in those with mild or no barrier disturbance (p = 0.001). The Qalb as a marker for the leakiness of the BCSFB and, more indirectly, of the blood-brain barrier (BBB) was positively correlated with the incidence of leptomeningeal contrast enhancement seen on postcontrast fluid-attenuated inversion recovery (FLAIR) MRI (p = 0.003). Patients with a more pronounced brain barrier dysfunction recovered more slowly and stayed longer in the hospital.

Conclusions: The severity of meningeal BBB disturbance can be estimated on postcontrast FLAIR MRI, which may be of diagnostic value in patients with aseptic meningitis.

No MeSH data available.


Related in: MedlinePlus

Reibergram (CSF/serum quotient diagram) of all included patientsIncreasing albumin quotients reflect increasing blood-brain barrier dysfunction (x-axis). The cutoff value for brain barrier dysfunction depends on the patient's age and is therefore not marked. On the y-axis, the blue line separates blood-borne IgG (below the line) and intrathecal IgG synthesis (above the line). In our patient cohort, the CSF/serum albumin ratio (Qalb) was significantly higher in patients with leptomeningeal enhancement on postcontrast fluid-attenuated inversion recovery (FLAIR) imaging (red) than in those without leptomeningeal enhancement (green). QIgG = CSF/serum IgG ratio.
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Figure 1: Reibergram (CSF/serum quotient diagram) of all included patientsIncreasing albumin quotients reflect increasing blood-brain barrier dysfunction (x-axis). The cutoff value for brain barrier dysfunction depends on the patient's age and is therefore not marked. On the y-axis, the blue line separates blood-borne IgG (below the line) and intrathecal IgG synthesis (above the line). In our patient cohort, the CSF/serum albumin ratio (Qalb) was significantly higher in patients with leptomeningeal enhancement on postcontrast fluid-attenuated inversion recovery (FLAIR) imaging (red) than in those without leptomeningeal enhancement (green). QIgG = CSF/serum IgG ratio.

Mentions: Clinical data including age, sex, presenting symptoms and clinical course, duration of hospitalization, medication, and neurologic status at discharge were collected in all patients. Routine CSF analyses included leukocyte count, CSF protein concentration, Qalb, CSF/serum IgG ratio (QIgG), CSF culture, CSF serology (herpes simplex virus [HSV] IgG/IgM, varicella-zoster virus [VZV] IgG/IgM, measles IgG/IgM, mumps IgG/IgM, Borrelia burgdorferi IgG/IgM, syphilis, HIV), and PCR analysis for neurotropic viruses (HSV 1/2, VZV, CMV, Epstein-Barr virus, enterovirus, human herpesvirus 6). Brain barrier dysfunction and intrathecal synthesis of IgG were determined based on the method of Reiber.6 The resulting data are presented in Reibergrams (figure 1), discriminating the QIgG from the IgG/serum albumin ratio with hyperbolic reference range. The upper limit of the reference range for an intact brain barrier function is age-dependent and was calculated for each patient according to the formula Qalb < (4 + age/15) × 103.7 Brain barrier dysfunction was classified as mild (Qalb <10 × 103), moderate (Qalb 10–20 × 103), or severe (Qalb >20 × 103).8


Leptomeningeal contrast enhancement and blood-CSF barrier dysfunction in aseptic meningitis.

Alonso A, Eisele P, Ebert AD, Griebe M, Engelhardt B, Szabo K, Hennerici MG, Gass A - Neurol Neuroimmunol Neuroinflamm (2015)

Reibergram (CSF/serum quotient diagram) of all included patientsIncreasing albumin quotients reflect increasing blood-brain barrier dysfunction (x-axis). The cutoff value for brain barrier dysfunction depends on the patient's age and is therefore not marked. On the y-axis, the blue line separates blood-borne IgG (below the line) and intrathecal IgG synthesis (above the line). In our patient cohort, the CSF/serum albumin ratio (Qalb) was significantly higher in patients with leptomeningeal enhancement on postcontrast fluid-attenuated inversion recovery (FLAIR) imaging (red) than in those without leptomeningeal enhancement (green). QIgG = CSF/serum IgG ratio.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608759&req=5

Figure 1: Reibergram (CSF/serum quotient diagram) of all included patientsIncreasing albumin quotients reflect increasing blood-brain barrier dysfunction (x-axis). The cutoff value for brain barrier dysfunction depends on the patient's age and is therefore not marked. On the y-axis, the blue line separates blood-borne IgG (below the line) and intrathecal IgG synthesis (above the line). In our patient cohort, the CSF/serum albumin ratio (Qalb) was significantly higher in patients with leptomeningeal enhancement on postcontrast fluid-attenuated inversion recovery (FLAIR) imaging (red) than in those without leptomeningeal enhancement (green). QIgG = CSF/serum IgG ratio.
Mentions: Clinical data including age, sex, presenting symptoms and clinical course, duration of hospitalization, medication, and neurologic status at discharge were collected in all patients. Routine CSF analyses included leukocyte count, CSF protein concentration, Qalb, CSF/serum IgG ratio (QIgG), CSF culture, CSF serology (herpes simplex virus [HSV] IgG/IgM, varicella-zoster virus [VZV] IgG/IgM, measles IgG/IgM, mumps IgG/IgM, Borrelia burgdorferi IgG/IgM, syphilis, HIV), and PCR analysis for neurotropic viruses (HSV 1/2, VZV, CMV, Epstein-Barr virus, enterovirus, human herpesvirus 6). Brain barrier dysfunction and intrathecal synthesis of IgG were determined based on the method of Reiber.6 The resulting data are presented in Reibergrams (figure 1), discriminating the QIgG from the IgG/serum albumin ratio with hyperbolic reference range. The upper limit of the reference range for an intact brain barrier function is age-dependent and was calculated for each patient according to the formula Qalb < (4 + age/15) × 103.7 Brain barrier dysfunction was classified as mild (Qalb <10 × 103), moderate (Qalb 10–20 × 103), or severe (Qalb >20 × 103).8

Bottom Line: The Qalb as a marker for the leakiness of the BCSFB and, more indirectly, of the blood-brain barrier (BBB) was positively correlated with the incidence of leptomeningeal contrast enhancement seen on postcontrast fluid-attenuated inversion recovery (FLAIR) MRI (p = 0.003).Patients with a more pronounced brain barrier dysfunction recovered more slowly and stayed longer in the hospital.The severity of meningeal BBB disturbance can be estimated on postcontrast FLAIR MRI, which may be of diagnostic value in patients with aseptic meningitis.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology (A.A., P.E., A.D.E., M.G., K.S., M.G.H., A.G.), Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany; and Theodor Kocher Institute (B.E.), University of Bern, Bern, Switzerland.

ABSTRACT

Objective: To investigate the blood-CSF barrier (BCSFB) dysfunction in aseptic meningitis.

Methods: In our case series of 14 patients with acute aseptic meningitis, we compared MRI characteristics with CSF findings.

Results: Contrast enhancement in the sulcal space in a leptomeningeal pattern was visualized in 7 patients with BCSFB dysfunction categorized as moderate to severe as evidenced by the CSF/serum albumin ratio (Qalb) but was not present in those with mild or no barrier disturbance (p = 0.001). The Qalb as a marker for the leakiness of the BCSFB and, more indirectly, of the blood-brain barrier (BBB) was positively correlated with the incidence of leptomeningeal contrast enhancement seen on postcontrast fluid-attenuated inversion recovery (FLAIR) MRI (p = 0.003). Patients with a more pronounced brain barrier dysfunction recovered more slowly and stayed longer in the hospital.

Conclusions: The severity of meningeal BBB disturbance can be estimated on postcontrast FLAIR MRI, which may be of diagnostic value in patients with aseptic meningitis.

No MeSH data available.


Related in: MedlinePlus