Neuroimaging in encephalitis: analysis of imaging findings and interobserver agreement

Granerød, Julia; Davies, Nicholas W S; Mukonoweshuro, William; Mehta, Amrish; Das, Kumar; Lim, Ming; Solomon, Tom; Biswas, Shubhabrata; Rosella, Laura; Brown, David; Crowcroft, Natasha S.; Ambrose, Helen E.; Clewley, Jonathan P.; Walsh, Amanda L.; Morgan, Dilys; Cunningham, Richard; Zuckerman, Mark; Mutton, Kenneth J.; Ward, Katherine N.; Lunn, Michael P.; Irani, Sarosh R.; Vincent, Angela; Ford, C. S.; Rothwell, Emily S.; Tong, William P.; Lin, Jean-Pierre; Ahmed, Javeed; Cubitt, David; Hemingway, Cheryl; Muir, D. C. F.; Lyall, Hermione; Thompson, E. E.; Keir, Geoff; Worthington, Viki; Griffiths, Paul D.; Bennett, Susan L; Kneen, Rachel; Klapper, Paul E.

doi:10.1016/j.crad.2016.03.015

Cited by 46 publications

(34 citation statements)

References 25 publications

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“…In pyogenic meningitis the specificity of subdural effusion was 96.9% but sensitivity was only 14.2%. Granerod et al 4 found the overall sensitivity of neuroimaging for viral CNS infection to be 80%, while specificity was more than 95% with PPV of 100% and NPV of more than 90%, 8,5 which is also nearly similar to our study. Similar results are stated by Mei-Ling Sharon TAI et al 5 that the sensitivity of the imaging features for diagnosis of TBM was 88.9% and the specificity was 95.6%.…”

Section: Clinical Presentationsupporting

confidence: 91%

Imaging of CNS Infections with Clinico-pathological Correlation

Ojha¹,

Verma²,

Saran³

et al. 2019

IJCMR

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Introduction: CNS infections are an emerging health problem with poor prognosis if the treatment is not prompt and adequate. Thus, establishing a correct diagnosis is necessary to quickly start the appropriate treatment. This study was undertaken to study the etiology and the imaging spectrum of CNSI in and around western Uttar Pradesh in a tertiary health care set up and to correlate the neuro-imaging findings with clinic-pathological data. Material and Methods:In this Prospective Observational study 80 patients clinically suspected of CNS infection were studied by CT/MRI and the neuro imaging findings were correlated with clinical and CSF findings.Results: Based on clinical features, CSF findings, the treatment given and the response to treatment tuberculous infection (TBM) was most common infection (41.2%) followed by pyogenic meningitis (36.2%) and viral infection (22.5%). In 29 patients of pyogenic CNS infection most common imaging finding was leptomeningitis(62%) followed by pachymeningitis (31%), hydrocephalus (24.1%), abscess (6.8%), post vasculitic infarct(6.8%) and extra axial collection(6.8%). In 33 patients of tubercular CNS infection most common imaging finding was basal leptomeningitis (78.7%) followed by tuberculoma (72.7%), pachymeningitis (33.3%), hydrocephalus (27.2%), abscess (12.1%), post vasculitis infarct (12.1%) and spinal cord involvement in 1 (3%) patient. In the 18 viral CNS infection cases most common imaging finding was parenchymal hyperintensity on MRI or hypodensity on CT with/without peripheral vasogenic edema (94.4%) followed by leptomeningeal/pachymeningeal involvement (61.1%) and post vasculitis infarct (11.1%). Conclusion:The sensitivity of neuroimaging in pyogenic CNS infection was 81.2% and specificity was 93.7% while sensitivity of neuroimaging in tubercular CNS infection was 88.8% and specificity was 97.8% and in viral CNS infection sensitivity was 84.2% and specificity was 96.7%. There was significant association (p value <0.05) of basal leptomeningitis and granulomas on imaging with tubercular infection and parenchymal signal changes with viral infections.

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Section: Clinical Presentationsupporting

confidence: 91%

Imaging of CNS Infections with Clinico-pathological Correlation

Ojha¹,

Verma²,

Saran³

et al. 2019

IJCMR

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“…Neuroimaging can be negative acutely, but by 48 hours, over 90% of patients have MR brain imaging abnormalities and sensitivity approaches 100% at 3–10 days 4. T2-weighted and fluid-attenuated inversion recovery (FLAIR) images show markedly asymmetric but usually bilateral abnormalities in the limbic system, medial temporal lobes, insular cortices and inferolateral frontal lobes.…”

Section: Infectious Encephalitismentioning

confidence: 99%

Infectious encephalitis: mimics and chameleons

Toledano

Davies

2019

Pract Neurol

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Click here to listen to the Podcast ‘Query encephalitis’ is a common neurological consultation in hospitalised patients. Identifying the syndrome is only part of the puzzle. Although historically encephalitis has been almost synonymous with infection, we increasingly recognise parainfectious or postinfectious as well as other immune-mediated causes. We must also distinguish encephalitis from other causes of encephalopathy, including systemic infection, metabolic derangements, toxins, inherited metabolic disorders, hypoxia, trauma and vasculopathies. Here, we review the most important differential diagnoses (mimics) of patients presenting with an encephalitic syndrome and highlight some unusual presentations (chameleons) of infectious encephalitis.

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“…On the T2 sequences there can be noticed a hypersignal at the level of white substance of the cortex and hypo signal at the levels of hemorrhages. On the DWI and ADC sequences, a diffusion restriction is seen due to the cytotoxic edema, which is less intense compared to the one from a stroke (8,9). The EEG is modified in 80% of the cases of viral acute encephalitis.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic difficulties in vegetative epileptic seizures as a sign of acute viral encephalitis: case presentation

Iluţ

Nistor

Nemes

et al. 2020

BALNEO

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Acute encephalitis is a severe pathology represented by the inflammation of the brain parenchyma associated with neurological dysfunction. The etiology is predominantly viral or autoimmune, with different therapeutic approach. The typical manifestations include fever, epileptic seizures and neurological focal signs. The treatment consists in specific drug therapies regarding the etiology and rehabilitation therapies in case of incomplete recovery. We present a case of a 43-year-old woman with occipital cephalalgia and dizziness, associated with vesperal high blood pressure levels at the same hour daily. The brain MRI described possible acute encephalitis, with FLAIR and T2 hypersignal area on right parietal region and diffusion restriction. The lumbar puncture revealed no modifications and the EEG recordings showed irritative patterns. The acyclovir intravenous treatment and an antiepileptic drug were initiated. The repeated MRI revealed laminar necrosis which explained the vegetative epileptic seizures manifested with high blood pressure. The clinical status of the patient majorly improved due to specific treatment including rehabilitation interventions. Key words: acute viral encephalitis, vegetative epileptic seizures, laminar necrosis, cephalalgia, rehabilitation,

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Neuroimaging in encephalitis: analysis of imaging findings and interobserver agreement

Cited by 46 publications

References 25 publications

Imaging of CNS Infections with Clinico-pathological Correlation

Imaging of CNS Infections with Clinico-pathological Correlation

Infectious encephalitis: mimics and chameleons

Therapeutic difficulties in vegetative epileptic seizures as a sign of acute viral encephalitis: case presentation

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