MR Imaging of Acute Coccidioidal Meningitis

• Published in: American journal of neuroradiology : AJNR Vol. 20; no. 3; pp. 509 - 514
• Main Authors: Erly, William K, Bellon, Richard J, Seeger, Joachim F, Carmody, Raymond F
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL Am Soc Neuroradiology 01.03.1999; American Society of Neuroradiology
• Subjects: Acute Disease; Adult; Aged; Biological and medical sciences; Biopsy; Brain; Cerebral Infarction - diagnosis; Cerebral Infarction - microbiology; Cerebral Ventricles - microbiology; Cerebral Ventricles - pathology; Coccidioidomycosis - diagnosis; Corpus Callosum - microbiology; Corpus Callosum - pathology; Dilatation, Pathologic - diagnosis; Dilatation, Pathologic - microbiology; Female; Follow-Up Studies; Human mycoses; Humans; Hydrocephalus - diagnosis; Hydrocephalus - microbiology; Image Enhancement - methods; Infectious diseases; Magnetic Resonance Imaging; Male; Medical sciences; Meningitis, Fungal - diagnosis; Middle Aged; Mycoses; Mycoses of the nervous system; Temporal Lobe - microbiology; Temporal Lobe - pathology; Tomography, X-Ray Computed; Human; Nervous system diseases; Coccidioides immitis; Mycosis; Acute; Phycomycetes; Central nervous system; Exploration; Nuclear magnetic resonance imaging; Fungi; Infection; Central nervous system disease; Medical imagery; Meningitis; Thallophyta; Brain (vertebrata)
• ISSN: 0195-6108; 1936-959X

Our purpose was to describe the MR imaging findings in patients with acute coccidioidal meningitis. Fourteen patients (11 men, three women; 22-78 years old; mean age, 47 years) with coccidioidal meningitis underwent neuroimaging within 2 months of diagnosis. Thirteen patients had MR imaging and one had an initial CT study with a follow-up MR examination 5 months later. Initial and follow-up MR images were evaluated for the presence of ventricular dilatation, signal abnormalities, enhancement characteristics, sites of involvement, and evidence of white matter or cortical infarction. The patterns of enhancement were characterized as focal or diffuse. Pathologic specimens were reviewed in two patients. Ten of the 14 images obtained at the time of initial diagnosis showed evidence of meningitis. All of the initially abnormal studies showed enhancement in the basal cisterns, sylvian fissures, or pericallosal region. Subsequent studies, which were available for three of the four patients with normal findings initially, all eventually became abnormal, with focal enhancement seen on the initial abnormal examination. Other abnormalities seen at presentation included ventricular dilatation (six patients) and deep infarcts (four patients). Pathologic specimens in two patients showed focal collections of the organism corresponding to the areas of intense enhancement on MR images. Early in its disease course, coccidioidal meningitis may show areas of focal enhancement in the basal cisterns, which may progress to diffuse disease. Pathologically, the areas of enhancement represent focal collections of the organism. Deep infarcts and communicating hydrocephalus are associated findings.