Advertisement

Inflammatory Diseases of the Meninges

  • Stefan Rohde
Chapter
Part of the Medical Radiology book series (MEDRAD)

Abstract

Neuroimaging is of major importance in all cases of suspected infectious meningitis in order to get quick information about the extent of the disease, typical lesion patterns, and potential complications, such as hydrocephalus, involvement of the underlying brain parenchyma, or vasculitis. In bacterial meningitis, abnormal and asymmetrical enhancement of the leptomeninges and the subarachnoid space is typical. Initial neuroimaging has to rule out infectious foci of the skull base such as purulent sinusitis or mastoiditis. In patients with focal deficits or seizures, MRI is the tool of choice to diagnose vascular or septic complications. Neoplastic, viral, or fungal infections of the CNS may present with similar changes of the meninges; however, fungal meningitis normally causes a thicker and more nodular enhancement. In case of basal accentuation of the leptomeningeal contrast enhancement and conspicuous signal changes in the basal cisterns, one has to consider tuberculous meningitis for differential diagnosis, especially in patients with HIV infection. Non-infectious causes of meningeal enhancement comprise several primary and secondary tumors (e.g., CNS lymphoma, medulloblastoma, or breast cancer), granulomatous diseases, intracranial hypotension, and post-operative changes.

Keywords

Bacterial Meningitis Cranial Nerve Palsy Tuberculous Meningitis Intracranial Hypotension Basal Cistern 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Brightbill TC, Ihmeidan IH, Post MJD, Berger JR, Katz DA (1995) Neurosyphillis in HIV-positive and HIV-negative patients: neuroimaging findings. Am J Neuroradiol 16:703–711PubMedGoogle Scholar
  2. Chang KH, Han MH, Roh JK, Kim IO, Han MC, Kim CW (1990) Gd-DTPA-enhanced MR imaging of the brain in patients with meningitis: comparison with CT. Am J Neuroradiol 11(1):69–76PubMedGoogle Scholar
  3. Garg RK (2010) Tuberculous meningitis. Acta Neurol Scand 122(2):75–90PubMedGoogle Scholar
  4. Hähnel S, Storch-Hagenlocher B, Kress B, Stippich C, Sartor K, Forsting M, Seitz A, Jansen O (2005) Infectious diseases of brain parenchyma in adults: imaging and differential diagnosis aspects. Rofo 177(10):1349–1365PubMedCrossRefGoogle Scholar
  5. Kamra P, Azad R, Prasad KN, Jha S, Pradhan S, Gupta RK (2004) Infectious meningitis: prospective evaluation with magnetization transfer MRI. Br J Radiol 77(917):387–394PubMedCrossRefGoogle Scholar
  6. Kastrup O, Wanke I, Maschke M (2005) Neuroimaging of infections. NeuroRx 2(2):324–332PubMedCrossRefGoogle Scholar
  7. Smirniotopoulos JG, Murphy FM, Rushing EJ, Rees JH, Schroeder JW (2007) Patterns of contrast enhancement in the brain and meninges. Radiographics 27(2):525–551PubMedCrossRefGoogle Scholar
  8. Kawaguchi T, Sakurai K, Hara M, Muto M, Nakagawa M, Tohyama J, Oguri T, Mitake S, Maeda M, Matsukawa N, Ojika K, Shibamoto Y (2012). Clinico-radiological features of subarachnoid hyperintensity on diffusion-weighted images in patients with meningitis. Clin Radiol 67(4):306-312. Epub 2011 Dec 20. PMID: 22192625 [PubMed–in process]Google Scholar
  9. Srikanth SG, Taly AB, Nagarajan K, Jayakumar PN, Patil S (2007) Clinicoradiological features of tuberculous meningitis in patients over 50 years of age. J Neurol Neurosurg Psychiatry 78(5):536–538PubMedCrossRefGoogle Scholar
  10. Van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M (2004) Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 351(18):1849–1859PubMedCrossRefGoogle Scholar
  11. Weisfelt M, Hoogman M, van de Beek D, de Gans J, Dreschler WA, Schmand BA (2006) Dexamethasone and long-term outcome in adults with bacterial meningitis. Ann Neurol 60(4):456–468PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Division of NeuroradiologyHeidelberg University Medical CenterHeidelbergGermany

Personalised recommendations