Background: Varicella zoster virus [VZV] is a latent virus that can remain in the central nervous system. Reactivation of the virus can cause some neurologic manifestations, and myelitis is one of the rarest of them. In this report, we aimed to present the MRI features of long-segment cervical myelitis after VZV infection, which is rarely reported in the literature. Case Presentation: A 69-year-old patient, who was diagnosed with varicella zoster two months ago and treated with valacyclovir, was admitted to our clinic with worsening of his complaints and weakness in the right upper extremity. Neurological examination was normal in the left upper and bilateral lower extremities but the muscle strength in the right upper extremity was evaluated as 4/5 grade. While rare leukocytes [10 leukocytes/mm³, 50 erythrocytes/mm³, high protein level [46 mg/dl, ref.15-40 mg/dl]] were seen in the cerebrospinal fluid [CSF] analysis, no microorganisms were seen, and no growth was observed in the culture. VZV antibody-immunoglobulin G [Ab-IgG] was positive in CSF while polymerase chain reaction [PCR] for VZV was negative. On cervical MRI, lesions showing T2 hyperintensity were observed from the C3-4 level to the C7-T1 level, eccentrically located in the right paramedian spinal cord. On post contrast images, patchy heterogeneous contrast enhancement was noted in these regions of the spinal cord. When the patient's history, CSF features and MRI examinations were evaluated together, the lesions were consistent with VZV myelitis. The patient was started on valacyclovir treatment, and during the follow-up, the patient's complaints decreased, while no progress was observed in neurologic symptoms. Conclusion: As a result, we aimed to report the MRI features of this rare complication of varicella zoster and emphasize the necessity of keeping this in mind in the etiology myelitis, especially in cases with patchy enhancement, to achieve early diagnosis and treatment.
Background Multiple sclerosis (MS) and cerebral small vessel disease (CSVD) are relatively common radiological entities that occasionally necessitate differential diagnosis. Purpose To investigate the differences in magnetic resonance imaging (MRI) signal intensity (SI) between MS and CSVD related white matter lesions. Material and Methods On 1.5-T and 3-T MRI scanners, 50 patients with MS (380 lesions) and 50 patients with CSVD (395 lesions) were retrospectively evaluated. Visual inspection was used to conduct qualitative analysis on diffusion-weighted imaging (DWI)_b1000 to determine relative signal intensity. The thalamus served as the reference for quantitative analysis based on SI ratio (SIR). The statistical analysis utilized univariable and multivariable methods. There were analyses of patient and lesion datasets. On a dataset restricted by age (30–50 years), additional evaluations, including unsupervised fuzzy c-means clustering, were performed. Results Using both quantitative and qualitative features, the optimal model achieved a 100% accuracy, sensitivity, and specificity with an area under the curve (AUC) of 1 in patient-wise analysis. With an AUC of 0.984, the best model achieved a 94% accuracy, sensitivity, and specificity when using only quantitative features. The model's accuracy, sensitivity, and specificity were 91.9%, 84.6%, and 95.8%, respectively, when using the age-restricted dataset. Independent predictors were T2_SIR_max (optimal cutoff=2.1) and DWI_b1000_SIR_mean (optimal cutoff=1.1). Clustering also performed well with an accuracy, sensitivity, and specificity of 86.5%, 70.6%, and 100%, respectively, in the age-restricted dataset. Conclusion SI characteristics derived from DWI_b1000 and T2-weighted-based MRI demonstrate excellent performance in differentiating white matter lesions caused by MS and CSVD.
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