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MR imaging of acute coccidioidal meningitis
W K Erly1, R J Bellon, J F Seeger
1Department of Radiology, University of Arizona, Tucson 85724, USA.
Background And Purpose:
Our purpose was to describe the MR imaging findings in patients with acute coccidioidal meningitis.
Methods:
Fourteen patients (11 men, three women; 22-78 years old; mean age, 47 years) with coccidioidal meningitis underwent neuroimaging within 2 months of diagnosis. Thirteen patients had MR imaging and one had an initial CT study with a follow-up MR examination 5 months later. Initial and follow-up MR images were evaluated for the presence of ventricular dilatation, signal abnormalities, enhancement characteristics, sites of involvement, and evidence of white matter or cortical infarction. The patterns of enhancement were characterized as focal or diffuse. Pathologic specimens were reviewed in two patients.
Results:
Ten of the 14 images obtained at the time of initial diagnosis showed evidence of meningitis. All of the initially abnormal studies showed enhancement in the basal cisterns, sylvian fissures, or pericallosal region. Subsequent studies, which were available for three of the four patients with normal findings initially, all eventually became abnormal, with focal enhancement seen on the initial abnormal examination. Other abnormalities seen at presentation included ventricular dilatation (six patients) and deep infarcts (four patients). Pathologic specimens in two patients showed focal collections of the organism corresponding to the areas of intense enhancement on MR images.
Conclusion:
Early in its disease course, coccidioidal meningitis may show areas of focal enhancement in the basal cisterns, which may progress to diffuse disease. Pathologically, the areas of enhancement represent focal collections of the organism. Deep infarcts and communicating hydrocephalus are associated findings.
Insights
Early MR imaging in coccidioidal meningitis shows focal enhancement in basal cisterns, which can progress. Pathological findings confirm these areas represent organism collections, with infarcts and hydrocephalus as associated findings.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Coccidioidal meningitis is a serious fungal infection affecting the central nervous system.
- Accurate and early diagnosis is crucial for effective treatment and patient outcomes.
Purpose of the Study:
- To characterize the magnetic resonance (MR) imaging findings in patients diagnosed with acute coccidioidal meningitis.
- To correlate imaging findings with pathological evidence.
Main Methods:
- Retrospective review of neuroimaging studies (MR and CT) in 14 patients with coccidioidal meningitis.
- Evaluation of MR images for ventricular dilatation, signal abnormalities, enhancement patterns (focal/diffuse), and infarcts.
- Review of pathological specimens from two patients.
Main Results:
- Meningitis evidence was present in 10 of 14 initial MR studies, typically showing basal cistern enhancement.
- Progression from normal to abnormal findings was observed in follow-up studies.
- Associated findings included ventricular dilatation (6 patients) and deep infarcts (4 patients).
- Pathology confirmed focal collections of the organism in areas of intense MR enhancement.
Conclusions:
- Early MR imaging in coccidioidal meningitis may reveal focal basal cistern enhancement, potentially progressing to diffuse disease.
- Enhancing areas on MR correspond to focal collections of the Coccidioides organism.
- Communicating hydrocephalus and deep infarcts are significant associated findings.