Imaging of Topographic Viral CNS Infections

Rumboldt, Zoran

doi:10.1016/j.nic.2007.12.006

Cited by 22 publications

(14 citation statements)

References 38 publications

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“…This hypothesis corresponds with the data from the literature. Several reports have demonstrated the occurrence of hyperperfusion in HSV encephalitis in PET studies, as well as in other viral CNS infections in SPECT examinations [28]–[31]. Focal hyperperfusion as visualized by SPECT or PET appears to be an indicator of active inflammation of brain tissue [28], [29].…”

Section: Discussionmentioning

confidence: 95%

Value of Perfusion-Weighted MR Imaging in the Assessment of Early Cerebral Alterations in Neurologically Asymptomatic HIV-1-Positive and HCV-Positive Patients

et al. 2014

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Background and PurposeAsymptomatic central nervous system (CNS) involvement occurs in the early stage of the human immunodeficiency virus (HIV) infection. It has been documented that the hepatitis C virus (HCV) can replicate in the CNS. The aim of the study was to evaluate early disturbances in cerebral microcirculation using magnetic resonance (MR) perfusion-weighted imaging (PWI) in asymptomatic HIV-1-positive and HCV-positive patients, as well as to assess the correlation between PWI measurements and the clinical data.Materials and MethodsFifty-six patients: 17 HIV-1-positive non-treated, 18 HIV-1-positive treated with combination antiretroviral therapy (cART), 7 HIV-1/HCV-positive non-treated, 14 HCV-positive before antiviral therapy and 18 control subjects were enrolled in the study. PWI was performed with a 1.5T MR unit using dynamic susceptibility contrast (DSC) method. Cerebral blood volume (CBV) measurements relative to cerebellum (rCBV) were evaluated in the posterior cingulated region (PCG), basal ganglia (BG), temporoparietal (TPC) and frontal cortices (FC), as well as in white matter of frontoparietal areas. Correlations of rCBV values with immunologic data and liver histology activity index (HAI) were analyzed.ResultsSignificantly lower rCBV values were found in the right TPC and left FC as well as in PCG in HIV-1-positive naïve (p = 0.009; p = 0.020; p = 0.012), HIV-1 cART treated (p = 0.007; p = 0.009; p = 0.033), HIV-1/HCV-positive (p = 0.007; p = 0.027; p = 0.045) and HCV-positive patients (p = 0.010; p = 0.005; p = 0.045) compared to controls. HIV-1-positive cART treated and HIV-1/HCV-positive patients demonstrated lower rCBV values in the right FC (p = 0.009; p = 0.032, respectively) and the left TPC (p = 0.036; p = 0.005, respectively), while HCV-positive subjects revealed lower rCBV values in the left TPC region (p = 0.003). We found significantly elevated rCBV values in BG in HCV-positive patients (p = 0.0002; p<0.0001) compared to controls as well as to all HIV-1-positive subjects. There were no significant correlations of rCBV values and CD4 T cell count or HAI score.ConclusionsPWI examination enables the assessment of HIV-related as well as HCV-related early cerebral dysfunction in asymptomatic subjects. HCV-infected patients seem to reveal the most pronounced perfusion changes.

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Section: Discussionmentioning

confidence: 95%

Value of Perfusion-Weighted MR Imaging in the Assessment of Early Cerebral Alterations in Neurologically Asymptomatic HIV-1-Positive and HCV-Positive Patients

et al. 2014

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“…DWI can demonstrate multifocal areas of restricted diffusion involving the cortex, subcortical white matter, and deep gray nuclei during the acute phase of these diseases and is useful for distinguishing areas of cytotoxic edema from vasogenic edema [243]. The specific patterns of T2 prolongation and diffusion change in nonherpetic and other viral encephalitides can be found in primary articles and reviews on the topic [243][244][245][246]. Viral encephalitis can also present with, and is on the differential diagnosis for, a reversible splenial lesion [246,247] (Table 2.10).…”

Section: Encephalitismentioning

confidence: 99%

“…The specific patterns of T2 prolongation and diffusion change in nonherpetic and other viral encephalitides can be found in primary articles and reviews on the topic [243][244][245][246]. Viral encephalitis can also present with, and is on the differential diagnosis for, a reversible splenial lesion [246,247] (Table 2.10).…”

Section: Encephalitismentioning

confidence: 99%

Clinical Applications of Diffusion

Forghani

Schaefer

2011

Functional Neuroradiology

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“…La TC del cráneo puede mostrar áreas focales o difusas de atenuación en los ganglios basales, la sustancia blanca periventricular, el hipocampo y el tallo cerebral, e incluso, hemorragias del puente (39,40). La resonancia magnética puede ser normal o señalar en la secuencia de T2 imágenes muy intensas en el tallo cerebral, hipocampo, hipotálamo, sustancia blanca subcortical y profunda, y sustancia gris cortical y profunda, con diversos grados de intensidad, según el estado de la enfermedad.…”

Section: Figuraunclassified

“…La resonancia magnética puede ser normal o señalar en la secuencia de T2 imágenes muy intensas en el tallo cerebral, hipocampo, hipotálamo, sustancia blanca subcortical y profunda, y sustancia gris cortical y profunda, con diversos grados de intensidad, según el estado de la enfermedad. El realce con el gadolinio se ve claramente sólo en los estadios finales (5,6,39,40).…”

Section: Figuraunclassified

Encefalitis rábica humana por mordedura de murciélago en un área urbana de Colombia

2009

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Se presenta el caso de un adolescente con encefalitis rábica adquirida cuatro meses después de ser mordido por un murciélago en el área urbana de Floridablanca (Santander), Colombia. La complejidad de sus manifestaciones clínicas hizo muy difícil confirmar el diagnóstico antes de su muerte, principalmente por su período de incubación y la ausencia de casos similares en áreas diferentes de las selváticas. A pesar de las diversas estrategias terapéuticas, que incluyeron el denominado Protocolo de Milwaukee, el paciente falleció luego de 19 días de evolución y la necropsia confirmó que se trataba de una panencefalitis aguda necrosante de etiología viral rábica. La prueba de inmunofluorescencia directa en tejido cerebral fue positiva, lo mismo que la prueba biológica con ratones. La tipificación viral mostró la variante antigénica 3, cuyo reservorio principal es el vampiro hematófago Desmodus rotundus. Con el reporte de este caso de encefalitis rábica por mordedura de un murciélago, probablemente el primero informado en un área urbana de Colombia y de los pocos en América Latina, alertamos a las autoridades sanitarias y a la comunidad en salud, para aumentar y fortalecer las medidas preventivas en todos los niveles.Palabras clave: encefalitis, rabia, quirópteros, zoonosis, autopsia, Colombia. Human rabies encephalitis by a vampire bat bite in an urban area of ColombiaA case of rabies encephalitis is presented in a teenaged male, which developed four months after a bat bite in the urban area of Floridablanca, Santander Province, Colombia. The complex clinical manifestations prevented the confirmation of an antemortem diagnosis, principally because of the lengthy incubation period and the absence of other similar urban cases. Despite application of several therapies, including the Milwaukee protocol, the patient died 19 days after hospital admission. The autopsy revealed a necrotic, acute, pan-encephalitis of rabies virus etiology. The test of direct immunofluorescence in brain tissue was positive, as well as the biologic test in mice. Serological tests indicated it to be an antigenic variant type 3, whose main reservoir is the hematophagous vampire bat, Desmodus rotundus. This is probably the first case of bat-induced rabies reported in an urban community of Colombia and one of the few in Latin America. Although rabies encephalitis by a bat bite is rare, the case serves as a notice to health authorities and to the medical community to be alert to this risk. La rabia es una zoonosis viral que causa, aproximadamente, 50.000 casos nuevos anualmente en el mundo, o sea, casi uno cada 10 minutos. La mayoría de los casos ocurren en países en desarrollo y los perros son el principal vector en ellos (1). Sin embargo, existen otros

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Imaging of Topographic Viral CNS Infections

Cited by 22 publications

References 38 publications

Value of Perfusion-Weighted MR Imaging in the Assessment of Early Cerebral Alterations in Neurologically Asymptomatic HIV-1-Positive and HCV-Positive Patients

Value of Perfusion-Weighted MR Imaging in the Assessment of Early Cerebral Alterations in Neurologically Asymptomatic HIV-1-Positive and HCV-Positive Patients

Clinical Applications of Diffusion

Encefalitis rábica humana por mordedura de murciélago en un área urbana de Colombia

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