Document Detail


Focal parenchymal lesions in community-acquired bacterial meningitis in adults: a clinico-radiological study.
MedLine Citation:
PMID:  19618175     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Here, we analyzed the frequency, morphological pattern, and imaging characteristics of focal lesions as a consequence of community-acquired bacterial meningitis. We hypothesized that diffusion-weighted imaging combined with contrast-enhanced imaging, serial scanning, and multimodal vascular studies would provide further insight into the pathological basis of such parenchymal lesions in bacterial meningitis. METHODS: We reviewed clinical and imaging data (i.e., magnetic resonance tomography, magnetic resonance angiography, computed tomography angiography, digital subtraction angiography) of 68 adult patients admitted to our neurological intensive care unit between March 1998 and February 2009 with the diagnosis of community-acquired bacterial meningitis. RESULTS: We identified seven patients with parenchymal lesions. These lesions could be attributed to four morphological patterns: (1) territorial cerebral ischemia, (2) perforating vessels ischemia, (3) ischemia of presumed cardiac origin, and (4) isolated cortical lesions. Whereas the patterns (1) and (2) were associated with vasculopathy of large- and medium-sized vessels (as shown by cerebral vascular imaging), vessel imaging in (3) and (4) did not show abnormal findings. CONCLUSION: Our study implies that parenchymal lesions in acute bacterial meningitis are mainly ischemic and due to involvement of large-, medium-, and small-sized arteries of the brain. Diffusion-weighted imaging combined with conventional, CT-, or MR-based cerebral angiography revealed the underlying pathophysiological mechanisms in the majority of patients. Furthermore, we detected two patients with isolated bilateral cortical involvement and normal vessel imaging. These lesions might represent ischemia due to the involvement of small pial and intracortical arteries.
Authors:
Juri Katchanov; Eberhard Siebert; Matthias Endres; Randolf Klingebiel
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Publication Detail:
Type:  Journal Article     Date:  2009-07-18
Journal Detail:
Title:  Neuroradiology     Volume:  51     ISSN:  1432-1920     ISO Abbreviation:  Neuroradiology     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-10-07     Completed Date:  2010-01-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1302751     Medline TA:  Neuroradiology     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  723-9     Citation Subset:  IM    
Affiliation:
Department of Neurology, Campus Charit?? Mitte, Charit??, Berlin, Germany, juri.katchanov@charite.de.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Angiography, Digital Subtraction
Brain / blood supply*,  pathology*,  radiography
Brain Ischemia / cerebrospinal fluid,  pathology*,  radiography
Cerebral Angiography
Community-Acquired Infections / cerebrospinal fluid,  pathology,  radiography
Diffusion Magnetic Resonance Imaging
Female
Follow-Up Studies
Humans
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Male
Meningitis, Bacterial / cerebrospinal fluid,  pathology*,  radiography
Middle Aged
Tomography, X-Ray Computed
Young Adult

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