complications of bacterial meningitis: the utility of diffusion … · 2013. 5. 20. ·...

Complications of Bacterial Meningitis: The Utility of

Diffusion-weighted Imaging

Francisco Garcia-Morales, MD * Toshio Moritani, MD Akio Hiwatashi, MD Sven Ekholm, MD

Leena Ketonen, MD, PhD Per-Lennart Westesson, MD, PhD, DDS

University of Rochester Medical Center, NY

*VA Medical Center Dallas, TX

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DWI in complicated course of bacterial meningitis

•! 11 patients •! 6 males •! 5 females •!Age R=7days to 81 years

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DWI in complicated course of bacterial meningitis

•!Group B streptococcus 2 pt •!Strepto Pneumoniae 3 pt •!E coli 2 pt •!St meningitides 1 pt •!Bacillus sp 1 pt •! Fusibacterium 1 pt ? 1 pt

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MR patient evaluation

•! DWI and ADC maps (b=0, 1000sec/mm2, 3 orthogonal orientations)

•! T1, T2-weighted images •! Gd-enhanced T1-weighted images •! FLAIR •! MRA

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MR examination related to clinical presentation

•! 9 pt = 2-6 days •! 2 pt = 15-20 days

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Results

•!Different degree of brain infarction=6 pts

•!Brain infarction in bilateral fronto-parietal or parieto-occipital cortices = 3 pts.

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Brain Infarction

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Brain Infarction

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MRA COW

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DWI ACD

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DWI ADC

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Results •! Different degree of brain

infarction=6 pts •! Brain infarction in bilateral fronto-

parietal or parieto-occipital cortices = 3 pts.

•! Bilateral basal ganglia, deep white matter or corpus callosum = 3 pts.

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DWI

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DWI

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DWI

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Results

•!Purulent meningitis = 4 patients Convexity Hyperintensities with decrease ADC compared to CSF

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DWI

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DWI ADC

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Results

•!Purulent meningitis = 4 patients

•!Subdural empyema = 1 patient

•!Epidural empyema = 1 patient

•!Periorbital abscess = 1 patient

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DWI

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Results

•! Purulent meningitis = 4 patients

•! Subdural empyema = 1 patient

•! Periorbital abscess = 1 patient

•! Lemierre s syndrome = 1 patient

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Lemierre s syndrome

•! R jugular vein thrombosis

•! R sigmoid sinus thrombosis

•! R cavernous sinus trombophlebitis and abscess formation

•! Severe narrowing of the R ICA and watershed infarction.

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DWI ADC

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MRA DWI DSA

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DWI ADC

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Conclusions

•! DWI and ADC maps are useful to characterize complications of meningitis such as: –!Cerebral infarction –!Purulent leptomeningitis –!Subdural empyema –!Cavernous sinus abscess formation

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