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[CMV and VZV encephalitis in AIDS]
D Hassine1, F Gray, R Chekroun
1Service de Radiologie, Hôpital Raymond Poincaré, Garches.
Material And Methods:
Eighty patients were followed up prospectively. Histological correlation was obtained in 25 cases. All MRI examinations were performed on at 0.5 Tesla in T1-weighted sequences with and without gadolinium injection, and in axial or frontal T2-weighted spin echo sequences. Histological confirmation was obtained 30 days on average after the last MRI examination. Immunohistochemical stainings were performed in search of CMV, VZV, toxoplasma, HIV antigen and lymphoma.
Results:
CMV meningoencephalitis was found in 6 cases. In 3 of these it was manifested by atrophy, either isolated or associated with high signal intensity punctiform areas. Histology detected cortical or subcortical microglial nodules. In 2 cases MRI displayed abnormalities of subependymal nodular signals without enhancement, associated with punctiform abnormalities of subcortical signals. Histology showed subependymal foci of necrosis and abnormalities of white matter. In one case, MRI showed a ventriculitis confirmed by histology. VZV meningoencephalitis was diagnosed in 2 cases. MRI displayed abnormal basal ganglia related to meningitis (n = 1). All abnormalities were confirmed at histology.
Conclusion:
Some images (ventriculitis, infarction in basal ganglia, abnormal subependymal signal) would suggest VZV and CMV encephalitis. Other images (abnormalities of punctiform signals or atrophy) are not specific.
Insights
Cytomegalovirus (CMV) and Varicella-Zoster Virus (VZV) meningoencephalitis can be suggested by specific MRI findings, though some imaging abnormalities are not specific for these viral infections.
Area of Science:
- Neuroimaging
- Infectious Diseases
- Neuropathology
Context:
- Meningoencephalitis, particularly viral forms like Cytomegalovirus (CMV) and Varicella-Zoster Virus (VZV), presents diagnostic challenges.
- Magnetic Resonance Imaging (MRI) is crucial for evaluating brain inflammation, but specific imaging markers for viral etiologies require further elucidation.
- Histopathological correlation is essential for confirming diagnoses suggested by imaging findings.
Purpose:
- To evaluate the utility of MRI in diagnosing CMV and VZV meningoencephalitis.
- To correlate MRI findings with histological confirmations in a prospective patient cohort.
- To identify specific MRI patterns indicative of CMV and VZV encephalitis.
Summary:
- This study prospectively followed 80 patients, correlating MRI findings with histological data in 25 cases of suspected meningoencephalitis.
- MRI revealed characteristic findings in 6 cases of CMV meningoencephalitis (atrophy, punctiform lesions, subependymal abnormalities, ventriculitis) and 2 cases of VZV meningoencephalitis (basal ganglia abnormalities).
- While certain MRI features like ventriculitis and basal ganglia infarction suggest VZV and CMV encephalitis, other findings such as punctiform signals and atrophy are non-specific.
Impact:
- Provides insights into the diagnostic value of specific MRI findings for CMV and VZV meningoencephalitis.
- Highlights the importance of integrating imaging with histopathology for accurate diagnosis of viral brain infections.
- Contributes to the understanding of neuroimaging patterns in infectious encephalitis, aiding clinical decision-making.