Magnetic resonance imaging in the evaluation of patients with aseptic meningoencephalitis and connective tissue disorders

Abstract

-Objective: To describe the role of magnetic resonance imaging (MRI) in the evaluation of patients with chronic and recurrent aseptic meningitis.Method: A retrospective study of five patients with aseptic meningoencefalitis diagnosed by clinical and CSF findings. CT scans showed without no relevant findings. Results: MRI showed small multifocal lesions hyperintense on T2 weighted images and FLAIR, with mild or no gadolinium enhancement, mainly in periventricular and subcortical regions. Meningoencephalitis preceded the diagnosis of the underlying disease in four patients (Behçet´s disease or systemic lupus erythematosus). After the introduction of adequate treatment for the rheumatic disease, they did not present further symptoms of aseptic meningoencephalitis. Conclusion: Aseptic meningoencephalitis can be an early presentation of an autoimmune disease. It is important to emphasize the role of MRI in the diagnosis and follow-up of these patients.KEY WORDS: magnetic resonance imaging, CNS vasculitis, aseptic meningitis, systemic lupus erythematosus, lupus, Behçet disease.Ressonância magnética na avaliação de pacientes com meningoencefalite asséptica e doenças do tecido conjuntivo RESUMO -Objetivo: Investigar a importância da ressonância magnética (RM) na avaliação de pacientes com meningite asséptica crônica ou recorrente. Método: Este é um estudo retrospectivo incluindo cinco pacientes com meningite asséptica crônica ou recorrente diagnosticada com base nos dados clínicos e exame do líquido cefalorraquidiano. Os exames de tomografia computadorizada de crânio não evidenciaram achados relevantes. Resultados: A RM mostrou pequenas lesões multifocais hiperintensas em T2 e FLAIR, com pouco ou nenhum realce após injeção de gadolínio, sobretudo nas regiões periventriculares e subcorticais. O quadro de meningoencefalite precedeu o diagnóstico da doença de base (Behçet ou lupus) em quatro pacientes. Após a introdução do tratamento adequado para a doença reumatológica estes pacientes não apresentaram mais sintomas de meningoencefalite. Conclusão: Meningite asséptica pode ser uma das manifestações precoces de doença autoimune. É importante salientar o papel da RM no diagnóstico e acompanhamento desses pacientes. PALAVRAS-CHAVE: ressonância magnética, vasculite SNC, meningite asséptica, lupus eritematoso sistêmico, doença de Behçet.

Systemic inflammatory disorders in patients admitted for aseptic meningitis

“…Similarly, other groups have reported that small cortical or subcortical lesions hyperintense in T2 weighting are consistent with small vessel vasculitis and that gadolinium enhancement in T1 weighting in subarachnoid spaces suggests systemic disease rather than idiopathic meningitis. 14,15 Despite a tendency for a higher protein level in CSF to be associated with SID, we did not find any significant differences in the CSF analysis between idiopathic and SIDrelated meningitis. Some patients with idiopathic meningitis and no clear-cut SID appear to have 'borderline' characteristics, including the presence of extraneurological signs with abnormal MRI findings, with some patients requiring steroid therapy.…”

Relapsing Polychondritis with Meningoencephalitis Refractory to Immunosuppressant Therapy

“…Based on his neurological presentation, his ear lobe biopsy finding, brain MRI findings [ 3 ], and negative serologies, he was given a diagnosis of RP with meningoencephalitis.…”

The Importance of Toxoplasma Gondii Infection in Diseases Presenting With Headaches. Headaches and Aseptic Meningitis May Be Manifestations of the Jarisch-Herxheimer Reaction

“…MRI findings of small cortical and subcortical multifocal lesions hypointense in T1 weighted and hyperintense in T2 with mild or no gadolinium enhancement suggestive of small vessel vasculitis, mainly in periventricular and subcortical regions, is suggestive of chronic or recurrent AM (Appenzeller et al, 2000).…”