病毒性脑膜炎柯萨奇病毒课件.ppt

Case Discussion Head and Neck Sect 1: case discussion Sect 2: Radiology digest History Pulsated headache and dizziness for 2Ws occiput Temperature:37.5 cervical spondylosis with scorpion venom injection 1w before symptom 2008-11-20 2008-12-3 Definitions Inflammatory infiltration of the pia mater, arachnoid,and CSF Commonly related to hematogenous dissemination from a distant infection Can be divided into acute pyogenic (bacterial),lymphocytic (viral), and chronic (TB) meningitis General Imanging Features Best diagnostic clue: Positive CSF by lumbar puncture Location: Subarachnoid space, pia enhance Morphology Smooth, intense leptomeningeal enhancement typical TB, fungal meningitis often basilar and confluent; may be nodular Imaging： normal early findings nonspecific Imaging best delineates complications Hydrocephalus often occurs as early complication CT Findings NECT most commonly no abnormal fidings Mild ventricular enlargement Subarachnoid space enlargement Sulci Basal cisterns effacement CECT Enhancing: exudate in sulci, cisterns Low density areas : perfusion alterations CTA: Arterial narrowing, occlusion MR Findings Tl WI: Exudate is isointense T2WI: Exudate is hyperintense FLAIR: Hyperintense signal in sulci, cisterns DWI Variable, may show restriction Most useful for vascular complications Tl C+: Exudate typically enhances MRA: Arterial narrowing, occlusion Complications Extraventricular obstructive hydrocephalus Ventriculitis, choroid plexitis Abscess, empyema, effusion Cerebrovascular complications (arteritis, infarct, venous thrombosis) Cerebral edema, infarction DWI useful in depicting perfusion alterations Another case Torulopsis neoformans Another case Klebsiella pneumoniae DIFFERENTIAL DIAGNOSIS Carcinomatous meningitis Breast, lung most common distant primary tumors Primary CNS tumors include: GBM, medulloblastoma,pineal tumors, choroid plexus tumors Primary tumor often known Neurosarcoidosis Lacy leptomeningeal enhancement typical May have ve