leptomeningitis

Bakterielle
Meningitis; T1w-Kernspinaufnahme mit Kontrastmittel
Wikipedia • CC BY-SA 3.0
Postcontrast
Fluid-attenuated inversion recovery (FLAIR) MRI of a case of meningitis. It shows the enhancement of meninges at the tentorium and in the parietal region, with evidence of dilated ventricles.
Wikipedia • CC BY 3.0
Teenager with
left orbital and forehead swelling. Sagittal CT with contrast of the brain shows frontal and left maxillary sinusitis and extensive soft tissue swelling anterior to the forehead (upper left) and destruction of the anterior left frontal bone in the frontal sinus and extensive soft tissue swelling anterior to the left orbit (upper right). Coronal (lower left) and sagittal (lower right) T1 MRI with contrast of the brain shows diffuse meningeal enhancement, subdural empyemas along the falx and both cerebral convexities, and multiple large non-enhancing subgaleal fluid collections in the left scalp.The diagnosis was meningitis, subdural empyema, and Pott puffy tumor as complications of sinusitis.
pediatricimaging.org • CC-by-nc-sa 4.0
Ureaplasma
parvum meningitis following atypical choroid plexus papilloma resection in an adult patient: a case report and literature review. A Enhanced preoperative MRI showing a left temporal lobe-lateral ventricle tumor. B CT scans on the first day after surgery demonstrating that the tumor had been removed and replaced with CSF, with the opening of the left lateral ventricles. C Enhanced MRI images on the 43rd day after surgery demonstrating complete tumor resection
bmcinfectdis.biomedcentral.com • CC-by-4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Leptomeningitis, which is more commonly referred to as meningitis, represents inflammation of the subarachnoid space (i.e. arachnoid mater and pia mater) caused by an infectious or noninfectious process.

Pathology

Etiology
Infective
  • pyogenic meningitis
    • elderly
      • Streptococcus pneumoniae
      • Listeria monocytogenes
      • Neisseria meningitidis
      • Gram negative bacilli
    • adults
      • Streptococcus pneumoniae
      • Neisseria meningitidis
      • Group B streptococcus
    • children
      • Neisseria meningitidis
    • infants
      • Streptococcus pneumoniae
      • Neisseria meningitidis
    • neonates
      • Group B streptococcus
      • Escherichia coli
      • Listeria monocytogenes
  • viral meningitis
    • Enterovirus
    • JC virus meningitis
  • mycobacterial meningitis
  • fungal meningitis

For a further discussion related to other etiological agents and other infective processes in the CNS, please refer to CNS infectious diseases.

Aseptic meningitis

Radiographic features

CT
  • may be normal
  • subtle hydrocephalus
  • hyperdensity around basal cisterns (especially in tuberculosis) 
  • leptomeningeal enhancement
  • complications or sources of the meningitis
MRI
  • T1: may be normal; sulci may appear less hypointense than normal
  • T1 C+ (Gd): leptomeningeal enhancement
  • FLAIR: demonstrates hyperintense signal in CSF space, especially in the sulci
  • FLAIR C+ (Gd): has shown to be more sensitive and specific than T1 C+ (Gd) sequence in spotting leptomeningeal enhancement
  • MR angiography: arterial narrowing or occlusion

Treatment and prognosis

Complications

The complications of meningitis can be remembered using the mnemonic HACTIVE.

See also

Siehe auch:
und weiter: