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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