Limits...
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

Exemplary MRI of a patient with contrast enhancement on postcontrast FLAIRMRI of a 54-year-old patient with viral meningitis caused by varicella-zoster virus. (A) Unenhanced precontrast fluid-attenuated inversion recovery (FLAIR) images. On postcontrast FLAIR images (B), sulcal contrast enhancement and a fine hyperintense lining can be seen, probably involving the leptomeninges in the absence of obvious white or gray matter lesions on both FLAIR and postcontrast T1-weighted MRI (C). The magnified inserts highlight sulcal enhancement.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4608759&req=5

Figure 2: Exemplary MRI of a patient with contrast enhancement on postcontrast FLAIRMRI of a 54-year-old patient with viral meningitis caused by varicella-zoster virus. (A) Unenhanced precontrast fluid-attenuated inversion recovery (FLAIR) images. On postcontrast FLAIR images (B), sulcal contrast enhancement and a fine hyperintense lining can be seen, probably involving the leptomeninges in the absence of obvious white or gray matter lesions on both FLAIR and postcontrast T1-weighted MRI (C). The magnified inserts highlight sulcal enhancement.

Mentions: On the initial MRI, no parenchymal signal alterations were detected in precontrast sequences including native FLAIR imaging in any of the patients. On postcontrast FLAIR images, 7/14 patients showed leptomeningeal and/or sulcal contrast enhancement. In 4/7, a distinct leptomeningeal enhancement was present along each cerebral lobe of both hemispheres and the cerebellum; in 3/7, contrast enhancement was more subtle and confined to the supratentorial leptomeninges. An example of ubiquitous contrast enhancement of the meninges in a patient with meningitis caused by VZV is given in figure 2. On contrast-enhanced T1-weighted images, no parenchymal or meningeal signal abnormalities were noted.


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)

Exemplary MRI of a patient with contrast enhancement on postcontrast FLAIRMRI of a 54-year-old patient with viral meningitis caused by varicella-zoster virus. (A) Unenhanced precontrast fluid-attenuated inversion recovery (FLAIR) images. On postcontrast FLAIR images (B), sulcal contrast enhancement and a fine hyperintense lining can be seen, probably involving the leptomeninges in the absence of obvious white or gray matter lesions on both FLAIR and postcontrast T1-weighted MRI (C). The magnified inserts highlight sulcal enhancement.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Exemplary MRI of a patient with contrast enhancement on postcontrast FLAIRMRI of a 54-year-old patient with viral meningitis caused by varicella-zoster virus. (A) Unenhanced precontrast fluid-attenuated inversion recovery (FLAIR) images. On postcontrast FLAIR images (B), sulcal contrast enhancement and a fine hyperintense lining can be seen, probably involving the leptomeninges in the absence of obvious white or gray matter lesions on both FLAIR and postcontrast T1-weighted MRI (C). The magnified inserts highlight sulcal enhancement.
Mentions: On the initial MRI, no parenchymal signal alterations were detected in precontrast sequences including native FLAIR imaging in any of the patients. On postcontrast FLAIR images, 7/14 patients showed leptomeningeal and/or sulcal contrast enhancement. In 4/7, a distinct leptomeningeal enhancement was present along each cerebral lobe of both hemispheres and the cerebellum; in 3/7, contrast enhancement was more subtle and confined to the supratentorial leptomeninges. An example of ubiquitous contrast enhancement of the meninges in a patient with meningitis caused by VZV is given in figure 2. On contrast-enhanced T1-weighted images, no parenchymal or meningeal signal abnormalities were noted.

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