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MR findings in acute and chronic coccidioidomycosis meningitis
C J Wrobel1, S Meyer, R H Johnson
1Division of Neurosurgery, UCSD 92103.
Purpose:
To characterize MR findings in acute and chronic coccidioidomycosis meningitis and relate the imaging features to the clinical course.
Methods:
We reviewed MR scans and clinical findings of 12 patients with coccidioidal meningitis.
Results:
Patients with active or untreated disease were found to have hydrocephalus and intense enhancement of the cervical subarachnoid space, basilar, sylvian, and interhemispheric cisterns on postcontrast MR scans. Focal parenchymal signal abnormalities suggesting ischemia or infarction were common. Abnormal MR enhancement decreases during therapy, although patients develop cortical and/or brain stem atrophy.
Conclusions:
Widespread cisternal and cervical subarachnoid meningeal involvement is common in coccidioidal meningitis. Serial contrast MR imaging reflects the effects of therapy in patients with coccidioidal meningitis.
Insights
Magnetic resonance imaging (MRI) reveals characteristic findings in coccidioidomycosis meningitis, including hydrocephalus and subarachnoid enhancement. Serial MRI can monitor treatment response and disease progression in patients.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Coccidioidomycosis meningitis is a serious fungal infection affecting the central nervous system.
- Accurate characterization of imaging findings is crucial for diagnosis and management.
- Magnetic resonance (MR) imaging plays a key role in visualizing meningeal inflammation and its complications.
Purpose of the Study:
- To detail MR imaging features of acute and chronic coccidioidomycosis meningitis.
- To correlate these imaging findings with the clinical progression of the disease.
Main Methods:
- Retrospective review of MR scans from 12 patients diagnosed with coccidioidal meningitis.
- Analysis of clinical data alongside MR imaging findings.
Main Results:
- Active or untreated coccidioidomycosis meningitis showed hydrocephalus and intense leptomeningeal enhancement, particularly in basal and cervical regions.
- Ischemic or infarct-like parenchymal abnormalities were frequently observed on MR scans.
- Therapy led to decreased MR enhancement but was associated with the development of cortical and brainstem atrophy.
Conclusions:
- Extensive cisternal and cervical subarachnoid involvement is a hallmark of coccidioidomycosis meningitis.
- Serial contrast-enhanced MR imaging is valuable for assessing therapeutic effects and disease evolution in coccidioidal meningitis.