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A prospective study of magnetic resonance imaging patterns of central nervous system infections in pediatric age group and young adults and their clinico-biochemical correlation.

Gupta K, Banerjee A, Saggar K, Ahluwalia A, Saggar K - J Pediatr Neurosci (2016 Jan-Mar)

Bottom Line: We found that most of the children belong to 1-10 years age group.Leptomeningeal enhancement is predominant in pyogenic meningitis.Basilar meningitis in the presence of tuberculomas is highly sensitive and specific for tuberculosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiodiagnosis, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

ABSTRACT

Background: Infections of the central nervous system (CNS) are common and routinely encountered. Our aim was to evaluate the neuroimaging features of the various infections of the CNS so as to differentiate them from tumoral, vascular, and other entities that warrant a different line of therapy.

Aims: Our aim was to analyze the biochemical and magnetic resonance imaging (MRI) features in CNS infections.

Settings and design: This was a longitudinal, prospective study over a period of 1½ years.

Subjects and methods: We studied cerebrospinal fluid (CSF) findings and MRI patterns in 27 patients of 0-20 years age group with clinical features of CNS infections. MRI was performed on MAGNETOM Avanto 18 Channel 1.5 Tesla MR machine by Siemens India Ltd. The MRI protocol consisted of diffusion-weighted and apparent diffusion coefficient imaging, turbo spin echo T2-weighted, spin echo T1-weighted, fluid-attenuated inversion recovery (FLAIR), and gradient-echo in axial, FLAIR in coronal, and T2-weighted in sagittal plane. Contrast-enhanced T1-weighted sequence and MR spectroscopy were done whenever indicated.

Results and conclusions: We found that most of the children belong to 1-10 years age group. Fungal infections were uncommon, mean CSF adenosine deaminase values specific for tuberculosis and mean CSF glucose-lowered in pyogenic. Hemorrhagic involvement of thalamus with/without basal ganglia and brainstem involvement may indicate Japanese encephalitis or dengue encephalitis. Diffusion restriction or hemorrhage in not expected in the brainstem afflicted lesions of rabies. Congenital cytomegalovirus can cause cortical malformations. T1 hyperintensities with diffusion restriction may represent viral encephalitis. Lesions of acute disseminated encephalomyelitis (ADEM) may mimic viral encephalitis. Leptomeningeal enhancement is predominant in pyogenic meningitis. Basilar meningitis in the presence of tuberculomas is highly sensitive and specific for tuberculosis.

No MeSH data available.


Related in: MedlinePlus

Magnetic resonance imaging in dengue encephalitis, axial T2-weighted image (a) reveals symmetrical hyperintense signal in thalami, blooming on gradient-echo (b) and diffusion restriction appearing hyperintense on b1000 (c) with lowered apparent diffusion coefficient values (not shown). Sagittal T2-weighted image (d) in another patient shows hyperintense signal in cerebellum and brainstem in addition to thalami
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Figure 1: Magnetic resonance imaging in dengue encephalitis, axial T2-weighted image (a) reveals symmetrical hyperintense signal in thalami, blooming on gradient-echo (b) and diffusion restriction appearing hyperintense on b1000 (c) with lowered apparent diffusion coefficient values (not shown). Sagittal T2-weighted image (d) in another patient shows hyperintense signal in cerebellum and brainstem in addition to thalami

Mentions: Two patients presented with fever, altered sensorium and thrombocytopenia. Dengue serology was positive in both. MRI revealed bilateral thalamic involvement in both the patients [Figure 1a]. Diffusion restriction and hemorrhage were seen in one patient [Figure 1b and c]. Leptomeningeal enhancement was seen in one patient. Cerebellar and brainstem involvement [Figure 1d] were seen in another patient.


A prospective study of magnetic resonance imaging patterns of central nervous system infections in pediatric age group and young adults and their clinico-biochemical correlation.

Gupta K, Banerjee A, Saggar K, Ahluwalia A, Saggar K - J Pediatr Neurosci (2016 Jan-Mar)

Magnetic resonance imaging in dengue encephalitis, axial T2-weighted image (a) reveals symmetrical hyperintense signal in thalami, blooming on gradient-echo (b) and diffusion restriction appearing hyperintense on b1000 (c) with lowered apparent diffusion coefficient values (not shown). Sagittal T2-weighted image (d) in another patient shows hyperintense signal in cerebellum and brainstem in addition to thalami
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4862288&req=5

Figure 1: Magnetic resonance imaging in dengue encephalitis, axial T2-weighted image (a) reveals symmetrical hyperintense signal in thalami, blooming on gradient-echo (b) and diffusion restriction appearing hyperintense on b1000 (c) with lowered apparent diffusion coefficient values (not shown). Sagittal T2-weighted image (d) in another patient shows hyperintense signal in cerebellum and brainstem in addition to thalami
Mentions: Two patients presented with fever, altered sensorium and thrombocytopenia. Dengue serology was positive in both. MRI revealed bilateral thalamic involvement in both the patients [Figure 1a]. Diffusion restriction and hemorrhage were seen in one patient [Figure 1b and c]. Leptomeningeal enhancement was seen in one patient. Cerebellar and brainstem involvement [Figure 1d] were seen in another patient.

Bottom Line: We found that most of the children belong to 1-10 years age group.Leptomeningeal enhancement is predominant in pyogenic meningitis.Basilar meningitis in the presence of tuberculomas is highly sensitive and specific for tuberculosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiodiagnosis, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

ABSTRACT

Background: Infections of the central nervous system (CNS) are common and routinely encountered. Our aim was to evaluate the neuroimaging features of the various infections of the CNS so as to differentiate them from tumoral, vascular, and other entities that warrant a different line of therapy.

Aims: Our aim was to analyze the biochemical and magnetic resonance imaging (MRI) features in CNS infections.

Settings and design: This was a longitudinal, prospective study over a period of 1½ years.

Subjects and methods: We studied cerebrospinal fluid (CSF) findings and MRI patterns in 27 patients of 0-20 years age group with clinical features of CNS infections. MRI was performed on MAGNETOM Avanto 18 Channel 1.5 Tesla MR machine by Siemens India Ltd. The MRI protocol consisted of diffusion-weighted and apparent diffusion coefficient imaging, turbo spin echo T2-weighted, spin echo T1-weighted, fluid-attenuated inversion recovery (FLAIR), and gradient-echo in axial, FLAIR in coronal, and T2-weighted in sagittal plane. Contrast-enhanced T1-weighted sequence and MR spectroscopy were done whenever indicated.

Results and conclusions: We found that most of the children belong to 1-10 years age group. Fungal infections were uncommon, mean CSF adenosine deaminase values specific for tuberculosis and mean CSF glucose-lowered in pyogenic. Hemorrhagic involvement of thalamus with/without basal ganglia and brainstem involvement may indicate Japanese encephalitis or dengue encephalitis. Diffusion restriction or hemorrhage in not expected in the brainstem afflicted lesions of rabies. Congenital cytomegalovirus can cause cortical malformations. T1 hyperintensities with diffusion restriction may represent viral encephalitis. Lesions of acute disseminated encephalomyelitis (ADEM) may mimic viral encephalitis. Leptomeningeal enhancement is predominant in pyogenic meningitis. Basilar meningitis in the presence of tuberculomas is highly sensitive and specific for tuberculosis.

No MeSH data available.


Related in: MedlinePlus