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Pediatric Meningeal Diseases: What Radiologists Need to Know.

Dhrumil Deveshkumar Patel1, Laura Z Fenton2, Swastika Lamture3

  • 1Department of Radiology, Nemours Children's Health, 1600 Rockland Rd., Wilmington, DE 19803, USA.

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This review categorizes pediatric meningeal diseases by imaging features to aid diagnosis. Differentiating causes of meningeal enhancement is crucial for effective treatment.

Keywords:
drop metastasismeningeal enhancementmeningitispachymeningeal enhancementpediatric

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Area of Science:

  • Pediatric Neurology
  • Neuroradiology
  • Infectious Diseases

Background:

  • Altered mental status and suspected meningeal disorders in children often prompt initial imaging before lumbar puncture.
  • Meningeal enhancement on imaging is a frequent finding across diverse pediatric pathologies, complicating diagnosis.
  • A systematic approach is needed to interpret meningeal enhancement in pediatric patients.

Purpose of the Study:

  • To propose a classification system for pediatric meningeal diseases based on distinct imaging characteristics.
  • To provide a comprehensive overview of clinical and imaging findings for conditions causing leptomeningeal or pachymeningeal enhancement in children and adolescents.
  • To facilitate differential diagnosis of meningeal lesions in pediatric patients.

Main Methods:

  • Literature review and synthesis of existing studies on pediatric meningeal disorders.
  • Categorization of diseases based on predominant imaging patterns of meningeal enhancement.
  • Detailed description of clinical presentations and radiological features for each category.

Main Results:

  • Meningeal enhancement in children can stem from infectious, autoimmune, neoplastic, tumor-like, vascular, and other miscellaneous disorders.
  • Identified conditions include various forms of meningitis, demyelinating diseases, CNS tumors, histiocytosis, vasculitis, and spontaneous intracranial hypotension.
  • Imaging findings, while often nonspecific, are presented in a structured manner to guide diagnostic workup.

Conclusions:

  • Categorizing meningeal diseases by imaging features aids in narrowing differential diagnoses for pediatric patients.
  • Accurate diagnosis based on imaging characteristics is essential for initiating specific and tailored treatment strategies.
  • Further research into specific imaging biomarkers could improve diagnostic accuracy for pediatric meningeal pathologies.