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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 nonspecific/parechoviral encephalitis, axial T1-weighted (a) image in 6 days old infant shows hyperintense focus in subcortical white matter in the right parietal region and in the left peritrigonal white matter (b). Axial diffusion-weighted (c) and apparent diffusion coefficient (d) shows diffusion restriction in these areas. T2-weighted images were normal in this case
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Figure 2: Magnetic resonance imaging in nonspecific/parechoviral encephalitis, axial T1-weighted (a) image in 6 days old infant shows hyperintense focus in subcortical white matter in the right parietal region and in the left peritrigonal white matter (b). Axial diffusion-weighted (c) and apparent diffusion coefficient (d) shows diffusion restriction in these areas. T2-weighted images were normal in this case

Mentions: Neuroimaging in six patients revealed punctate foci of T1 hyperintensity with diffusion restriction in bilateral cerebral hemispheres [Figure 2]. No evidence of lepto/pachymeningeal enhancement or hydrocephalus was seen. A possibility of viral encephalitis was entertained. CSF revealed only two cells. The patient was put on antivirals and improved. Similar spectrum of imaging has been described in the work of Verboon-Maciolek et al. who described T1 hyperintensities with diffusion restriction in bilateral cerebral hemispheres in an infant with parechovirus infection.[14]


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 nonspecific/parechoviral encephalitis, axial T1-weighted (a) image in 6 days old infant shows hyperintense focus in subcortical white matter in the right parietal region and in the left peritrigonal white matter (b). Axial diffusion-weighted (c) and apparent diffusion coefficient (d) shows diffusion restriction in these areas. T2-weighted images were normal in this case
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Magnetic resonance imaging in nonspecific/parechoviral encephalitis, axial T1-weighted (a) image in 6 days old infant shows hyperintense focus in subcortical white matter in the right parietal region and in the left peritrigonal white matter (b). Axial diffusion-weighted (c) and apparent diffusion coefficient (d) shows diffusion restriction in these areas. T2-weighted images were normal in this case
Mentions: Neuroimaging in six patients revealed punctate foci of T1 hyperintensity with diffusion restriction in bilateral cerebral hemispheres [Figure 2]. No evidence of lepto/pachymeningeal enhancement or hydrocephalus was seen. A possibility of viral encephalitis was entertained. CSF revealed only two cells. The patient was put on antivirals and improved. Similar spectrum of imaging has been described in the work of Verboon-Maciolek et al. who described T1 hyperintensities with diffusion restriction in bilateral cerebral hemispheres in an infant with parechovirus infection.[14]

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