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Leptomeningeal contrast enhancement and blood-CSF barrier dysfunction in aseptic meningitis
Angelika Alonso1, Philipp Eisele1, Anne D Ebert1
1Department of Neurology (A.A., P.E., A.D.E., M.G., K.S., M.G.H., A.G.), Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany; and Theodor Kocher Institute (B.E.), University of Bern, Bern, Switzerland.
Objective:
To investigate the blood-CSF barrier (BCSFB) dysfunction in aseptic meningitis.
Methods:
In our case series of 14 patients with acute aseptic meningitis, we compared MRI characteristics with CSF findings.
Results:
Contrast enhancement in the sulcal space in a leptomeningeal pattern was visualized in 7 patients with BCSFB dysfunction categorized as moderate to severe as evidenced by the CSF/serum albumin ratio (Qalb) but was not present in those with mild or no barrier disturbance (p = 0.001). The Qalb as a marker for the leakiness of the BCSFB and, more indirectly, of the blood-brain barrier (BBB) was positively correlated with the incidence of leptomeningeal contrast enhancement seen on postcontrast fluid-attenuated inversion recovery (FLAIR) MRI (p = 0.003). Patients with a more pronounced brain barrier dysfunction recovered more slowly and stayed longer in the hospital.
Conclusions:
The severity of meningeal BBB disturbance can be estimated on postcontrast FLAIR MRI, which may be of diagnostic value in patients with aseptic meningitis.
Insights
MRI can assess blood-CSF barrier (BCSFB) dysfunction in aseptic meningitis. Leptomeningeal contrast enhancement on MRI correlates with BCSFB leakiness, aiding diagnosis and predicting recovery.
Area of Science:
- Neurology
- Radiology
- Neuroimmunology
Background:
- Aseptic meningitis can cause blood-CSF barrier (BCSFB) dysfunction.
- Assessing BCSFB integrity is crucial for managing aseptic meningitis.
Purpose of the Study:
- To investigate BCSFB dysfunction in aseptic meningitis using MRI.
- To correlate MRI findings with cerebrospinal fluid (CSF) markers of barrier integrity.
Main Methods:
- Case series of 14 patients with acute aseptic meningitis.
- Comparison of MRI characteristics with CSF/serum albumin ratio (Qalb).
- Analysis of postcontrast fluid-attenuated inversion recovery (FLAIR) MRI for leptomeningeal enhancement.
Main Results:
- Leptomeningeal contrast enhancement on MRI was observed in patients with moderate to severe BCSFB dysfunction (p = 0.001).
- Qalb positively correlated with leptomeningeal enhancement on MRI (p = 0.003).
- Greater BCSFB dysfunction was linked to slower recovery and longer hospital stays.
Conclusions:
- Postcontrast FLAIR MRI can estimate the severity of meningeal blood-brain barrier (BBB) disturbance.
- MRI findings may hold diagnostic value for aseptic meningitis patients.
- MRI offers a non-invasive method to assess BCSFB integrity.
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