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MRI of recurrent isolated cerebral Whipple's disease
Fuldem Yildirim Dönmez1, Esra Ulu, Ceyla Başaran
1Department of Radiology, Başkent University School of Medicine, Ankara, Turkey. fuldemyildirim@yahoo.com
Abstract:
Whipple's disease is a rare systemic bacterial infection, characterized predominantly by gastrointestinal symptoms. Neurological symptoms are frequent in the course of the disease; however, a purely neurological presentation is uncommon. Diagnosis is confirmed with biopsy and polymerase chain reaction studies. Magnetic resonance imaging (MRI) findings vary, most commonly showing increased signal intensity on T2-weighted images. Contrast-enhanced images and diffusion- weighted imaging are useful to demonstrate meningeal enhancement and any accompanying infarcts. Brain biopsy is often performed, and MRI is crucial to guide the biopsy. Cerebral Whipple's disease is a long-lasting infection requiring long-term follow-up of these patients. MRI should be performed to detect any potential recurrence. We present a case of recurrent isolated cerebral Whipple's disease in a 68-year-old man with atypical presentation and MRI findings.
Insights
Whipple's disease is a rare bacterial infection. This case highlights recurrent isolated cerebral Whipple's disease with unusual MRI findings, emphasizing the need for vigilant follow-up.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Whipple's disease is a rare systemic bacterial infection, typically presenting with gastrointestinal issues.
- Neurological involvement is common, but isolated cerebral Whipple's disease is infrequent.
- Diagnosis relies on biopsy and polymerase chain reaction, with MRI aiding in detection and biopsy guidance.
Observation:
- The case involves a 68-year-old man with recurrent isolated cerebral Whipple's disease.
- The patient presented with an atypical neurological presentation.
- Unusual magnetic resonance imaging (MRI) findings were observed.
Findings:
- MRI findings in cerebral Whipple's disease can vary, often showing T2-weighted hyperintensities.
- Contrast-enhanced and diffusion-weighted MRI are valuable for detecting meningeal enhancement and infarcts.
- This case demonstrated atypical MRI features in recurrent isolated cerebral Whipple's disease.
Implications:
- Cerebral Whipple's disease requires long-term management and monitoring for recurrence.
- Regular MRI surveillance is essential for detecting potential relapses.
- This case underscores the importance of considering Whipple's disease in atypical neurological presentations and the role of advanced MRI techniques.
