□
PICTURES IN CLINICAL MEDICINE
□
Patchy Cerebral Meningitis: Spatiotemporal Resolution Using Contrast-Enhanced FLAIR-MRI Takayasu Mishima 1, Masa-aki Higuchi 1, Satoshi Nimura 2 and Yoshio Tsuboi 1 Key words: meningitis, magnetic resonance imaging, fluid-attenuated inversion recovery (FLAIR) (Intern Med 54: 1315-1316, 2015) (DOI: 10.2169/internalmedicine.54.4081)
day21
day41
day34
day53
Picture 1.
A 56-year-old man was admitted to the hospital with a headache and fever. His symptoms were interpreted as being indicative of bacterial meningitis, although a cerebrospinal fluid (CSF) analysis was not performed. Treatment with antibiotics was initiated, and he was transferred to our hospital, where a CSF analysis revealed pleocytosis. Antibiotic treatment only temporarily improved his headache, and a repeat CSF analysis indicated a decreased cell count. Meanwhile, magnetic resonance imaging (MRI) with contrast-
enhanced fluid-attenuated inversion recovery (FLAIR) demonstrated focal meningeal thickening, and time-lapse imaging showed that the lesion had moved, expanded and finally resolved, with signs of patchy meningitis (Picture 1). In addition, a biopsy specimen displayed thickening of the dura mater and inflammation of the leptomeninges (Picture 2). We speculate that patchy meningitis is a secondary phenomenon of bacterial meningitis. To our knowledge, this report is the first to track the spatiotemporal dynamics of inva-
１
Department of Neurology, Fukuoka University, School of Medicine, Japan and ２Department of Pathology, Fukuoka University, School of Medicine, Japan Received for publication September 11, 2014; Accepted for publication October 14, 2014 Correspondence to Dr. Yoshio Tsuboi, [email protected]
1315
Intern Med 54: 1315-1316, 2015
DOI: 10.2169/internalmedicine.54.4081
sive patchy meningitis using MRI and provides additional evidence that contrast-enhanced FLAIR is useful for assessing leptomeningeal disease (1, 2). The authors state that they have no Conflict of Interest (COI).
References 1. Parmar H, Sitoh YY, Anand P, Chua V, Hui F. Contrast-enhanced flair imaging in the evaluation of infectious leptomeningeal diseases. Eur J Radiol 58: 89-95, 2006. 2. Kremer S, Abu Eid M, Bierry G, et al. Accuracy of delayed postcontrast FLAIR MR imaging for the diagnosis of leptomeningeal infectious or tumoral diseases. J Neuroradiol 33: 285-291, 2006.
Picture 2.
Ⓒ 2015 The Japanese Society of Internal Medicine http://www.naika.or.jp/imonline/index.html
1316
PICTURES IN CLINICAL MEDICINE
□
Patchy Cerebral Meningitis: Spatiotemporal Resolution Using Contrast-Enhanced FLAIR-MRI Takayasu Mishima 1, Masa-aki Higuchi 1, Satoshi Nimura 2 and Yoshio Tsuboi 1 Key words: meningitis, magnetic resonance imaging, fluid-attenuated inversion recovery (FLAIR) (Intern Med 54: 1315-1316, 2015) (DOI: 10.2169/internalmedicine.54.4081)
day21
day41
day34
day53
Picture 1.
A 56-year-old man was admitted to the hospital with a headache and fever. His symptoms were interpreted as being indicative of bacterial meningitis, although a cerebrospinal fluid (CSF) analysis was not performed. Treatment with antibiotics was initiated, and he was transferred to our hospital, where a CSF analysis revealed pleocytosis. Antibiotic treatment only temporarily improved his headache, and a repeat CSF analysis indicated a decreased cell count. Meanwhile, magnetic resonance imaging (MRI) with contrast-
enhanced fluid-attenuated inversion recovery (FLAIR) demonstrated focal meningeal thickening, and time-lapse imaging showed that the lesion had moved, expanded and finally resolved, with signs of patchy meningitis (Picture 1). In addition, a biopsy specimen displayed thickening of the dura mater and inflammation of the leptomeninges (Picture 2). We speculate that patchy meningitis is a secondary phenomenon of bacterial meningitis. To our knowledge, this report is the first to track the spatiotemporal dynamics of inva-
１
Department of Neurology, Fukuoka University, School of Medicine, Japan and ２Department of Pathology, Fukuoka University, School of Medicine, Japan Received for publication September 11, 2014; Accepted for publication October 14, 2014 Correspondence to Dr. Yoshio Tsuboi, [email protected]
1315
Intern Med 54: 1315-1316, 2015
DOI: 10.2169/internalmedicine.54.4081
sive patchy meningitis using MRI and provides additional evidence that contrast-enhanced FLAIR is useful for assessing leptomeningeal disease (1, 2). The authors state that they have no Conflict of Interest (COI).
References 1. Parmar H, Sitoh YY, Anand P, Chua V, Hui F. Contrast-enhanced flair imaging in the evaluation of infectious leptomeningeal diseases. Eur J Radiol 58: 89-95, 2006. 2. Kremer S, Abu Eid M, Bierry G, et al. Accuracy of delayed postcontrast FLAIR MR imaging for the diagnosis of leptomeningeal infectious or tumoral diseases. J Neuroradiol 33: 285-291, 2006.
Picture 2.
Ⓒ 2015 The Japanese Society of Internal Medicine http://www.naika.or.jp/imonline/index.html
1316
