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(CEP)
[1–1] [PREPRINTER stage]
Imaging in Headache Medicine
Contrast-enhanced magnetic resonance imaging in carbamazepine-induced aseptic meningitis
Cephalalgia 0(0) 1 ! International Headache Society 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0333102415576722 cep.sagepub.com
Takashi Kageyama1, Ai Isohisa2, Nobuyuki Mori3 and Toshihiko Suenaga1
Figure 1. Brain MRI images of the patient. A coronal view of a contrast-enhanced T1-weighted image of the brain demonstrates diffuse enhancement along the inner surface of the skull, falx and tentorium simulating pachymeningitis (a), contrast-enhanced images on the 6th (b) and the 106th (c) day after carbamazepine discontinuation confirm the gradual resolution of enhancement.
A 55-year-old man complained of a headache after he had been taking 200 mg/day carbamazepine for 3 months to treat epilepsy. He demonstrated fever and meningisms and cerebrospinal fluid analysis revealed pleocytosis including 7% of eosinophils. A drug-induced lymphocyte stimulation test revealed high reactivity to carbamazepine. Contrast-enhanced brain magnetic resonance imaging (MRI) demonstrated diffuse enhancement along the inner surface of the skull, falx and tentorium, simulating pachymeningitis (Figure 1(a)) (1). We diagnosed this as a case of carbamazepine-induced aseptic meningitis (2). Carbamazepine was subsequently replaced with
zonisamide resulting in the immediate resolution of his headache and of the meningeal enhancement on MRI (Figure 1(b,c)).
References 1. Kioumehr F, Dadsetan MR, Feldman N, et al. Postcontrast MRI of cranial meninges: leptomeningitis versus pachymeningitis. J Comput Assist Tomogr 1995; 19: 713–720. 2. Hilton E and Stroh EM. Aseptic meningitis associated with administration of carbamazepine. J Infect Dis 1989; 159: 363–364.
1
Department of Neurology, Tenri Hospital, Japan General Internal Medicine, Tenri Hospital, Japan 3 Radiology, Tenri Hospital, Japan 2
Corresponding author: Takashi Kageyama, Department of Neurology, Tenri Hospital, 200, Mishima-cho, Tenri, Nara, 632-8552, Japan. Email: [email protected]
(CEP)
[1–1] [PREPRINTER stage]
Imaging in Headache Medicine
Contrast-enhanced magnetic resonance imaging in carbamazepine-induced aseptic meningitis
Cephalalgia 0(0) 1 ! International Headache Society 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0333102415576722 cep.sagepub.com
Takashi Kageyama1, Ai Isohisa2, Nobuyuki Mori3 and Toshihiko Suenaga1
Figure 1. Brain MRI images of the patient. A coronal view of a contrast-enhanced T1-weighted image of the brain demonstrates diffuse enhancement along the inner surface of the skull, falx and tentorium simulating pachymeningitis (a), contrast-enhanced images on the 6th (b) and the 106th (c) day after carbamazepine discontinuation confirm the gradual resolution of enhancement.
A 55-year-old man complained of a headache after he had been taking 200 mg/day carbamazepine for 3 months to treat epilepsy. He demonstrated fever and meningisms and cerebrospinal fluid analysis revealed pleocytosis including 7% of eosinophils. A drug-induced lymphocyte stimulation test revealed high reactivity to carbamazepine. Contrast-enhanced brain magnetic resonance imaging (MRI) demonstrated diffuse enhancement along the inner surface of the skull, falx and tentorium, simulating pachymeningitis (Figure 1(a)) (1). We diagnosed this as a case of carbamazepine-induced aseptic meningitis (2). Carbamazepine was subsequently replaced with
zonisamide resulting in the immediate resolution of his headache and of the meningeal enhancement on MRI (Figure 1(b,c)).
References 1. Kioumehr F, Dadsetan MR, Feldman N, et al. Postcontrast MRI of cranial meninges: leptomeningitis versus pachymeningitis. J Comput Assist Tomogr 1995; 19: 713–720. 2. Hilton E and Stroh EM. Aseptic meningitis associated with administration of carbamazepine. J Infect Dis 1989; 159: 363–364.
1
Department of Neurology, Tenri Hospital, Japan General Internal Medicine, Tenri Hospital, Japan 3 Radiology, Tenri Hospital, Japan 2
Corresponding author: Takashi Kageyama, Department of Neurology, Tenri Hospital, 200, Mishima-cho, Tenri, Nara, 632-8552, Japan. Email: [email protected]
