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"Bloomy rind sign" in varicella-zoster virus brainstem meningoencephalitis

Suzune Tsukamoto1, Mitsunori Kanagaki1, Yoichiro Hijikata1

  • 1Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan.

Radiology Case Reports
|August 5, 2024
PubMed

Insights

The bloomy rind sign on MRI, previously specific for lung cancer metastasis, can also appear in central nervous system infections like varicella-zoster virus meningoencephalitis. This finding broadens the differential diagnosis for this brain imaging abnormality.

Area of Science:

  • Neurology
  • Neuroradiology
  • Infectious Diseases

Background:

  • The bloomy rind sign, identified via magnetic resonance imaging (MRI) without contrast enhancement, presents as band-like abnormalities on the brainstem surface.
  • This sign has been historically regarded as a specific indicator of leptomeningeal metastasis, particularly from lung adenocarcinoma.

Observation:

  • A case study involving an 85-year-old male with symptoms of headache, fever, and cognitive decline was analyzed.
  • The patient was diagnosed with varicella-zoster virus brainstem meningoencephalitis.
  • MRI revealed brainstem surface hyperintensities on fluid-attenuated inversion recovery and diffusion-weighted imaging, mimicking the bloomy rind sign.

Findings:

  • The patient's imaging findings mimicked the bloomy rind sign.
  • Crucially, the patient presented no evidence of lung cancer or meningeal carcinomatosis.
  • The diagnosis was confirmed as central nervous system infection.

Implications:

  • The bloomy rind sign is not pathognomonic for leptomeningeal metastasis.
  • This imaging finding can also be indicative of central nervous system infections.
  • Broadening the differential diagnosis for the bloomy rind sign is essential for accurate patient management.
Keywords:
Bloomy rind signBrainstem meningoencephalitisVaricella-zoster virus

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