Neuroimaging of Emergent and Reemergent Infections

Carmo, Rafael Lourenço do; Simão, Aylla Keiner Alves; Amaral, Lázaro Luís Faria do; Inada, Bruno Shigueo Yonekura; Silveira, Camila Filardi; Campos, Christiane Monteiro de Siqueira; Freitas, Leonardo Furtado; Bonadio, Victor; Marussi, Victor Hugo Rocha

doi:10.1148/rg.2019190020

Cited by 39 publications

(22 citation statements)

References 60 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Albayram et al (Albayram et al, 2004) reported that in patients with ANE (not specifically ANE1) with restricted diffusion on neuroimaging can develop a ring pattern of high apparent diffusion coefficient (ADC) observed on the perimeter of lesions (reflecting vasogenic edema) with low ADC in the peri-core (indicating cytotoxic edema), and high ADC in the core representing hemorrhage and/or necrosis ( Figure 3). A distinguishing neuroradiographic finding amongst patients with ANE1, as demonstrated in the figures, is that there is a higher predilection for lesions in the bilateral thalami and pons as opposed to more diffuse findings (Wu et al, 2015, Carmo et al, 2019. Less frequently lesions can be found in the cervical spinal cord, cerebellum, medial temporal lobes or insular cortex, and other subcortical regions including mammillary bodies, hippocampus, amygdala, claustrum, and external capsule.…”

Section: Neurodiagnostic Studiesmentioning

confidence: 91%

“…MRI of the brain is more sensitive than CT for the diagnosis of ANE1, specifically T2-weighted and fluid attenuated inversion recovery (FLAIR)-weighted MRI, which classically shows symmetric hyperintense T2 signal prolongation in the bilateral thalami and brainstem, with thalamic lesions being the most distinctive feature of this disease (Figures 1-2) (Wu et al, 2015). Lesions are most commonly also hypointense on T1 and presence of restricted diffusion, often profound, has been reported (Carmo et al, 2019). Albayram et al (Albayram et al, 2004) reported that in patients with ANE (not specifically ANE1) with restricted diffusion on neuroimaging can develop a ring pattern of high apparent diffusion coefficient (ADC) observed on the perimeter of lesions (reflecting vasogenic edema) with low ADC in the peri-core (indicating cytotoxic edema), and high ADC in the core representing hemorrhage and/or necrosis ( Figure 3).…”

Section: Neurodiagnostic Studiesmentioning

confidence: 99%

See 1 more Smart Citation

Genetic Acute Necrotizing Encephalopathy Associated with RANBP2: Clinical and Therapeutic Implications in Pediatrics

Levine

Ahsan

et al. 2020

Multiple Sclerosis and Related Disorders

View full text Add to dashboard Cite

Genetic (also known as familial) acute necrotizing encephalopathy (ANE1) is a rare disease presenting with encephalopathy often following preceding viral febrile illness in patients with a genetic predisposition resulting from a missense mutation in the gene encoding RAN Binding Protein 2 (RANBP2). The acute episode is characterized by deterioration in consciousness, often with focal neurologic deficits and seizures. Additionally, symmetric multifocal brain lesions are seen in the bilateral thalami as well as other characteristic regions, involving both gray and white matter. Prognosis is variable, with a high mortality rate and most surviving patients having persistent neurologic deficits. Early treatment with high dose steroids is associated with a more favorable outcome, however the diagnosis is often overlooked resulting in delayed treatment. The RANBP2 mutation associated with ANE1 causes an incompletely penetrant predisposition to encephalopathy in the setting of febrile illness through a mechanism that remains elusive. There are several non-mutually exclusive hypotheses suggesting possible etiologies for this phenotype based on the many functions of RANBP2 within the cell. These include dysfunctions in nucleocytoplasmic trafficking and intracellular metabolic regulation, as well as cytokine storm, and abnormal distribution of mitochondria. This narrative review explores these key concepts of the RANBP2 mutation and its clinical and therapeutic implications in pediatric populations.

show abstract

Section: Neurodiagnostic Studiesmentioning

confidence: 91%

Section: Neurodiagnostic Studiesmentioning

confidence: 99%

Genetic Acute Necrotizing Encephalopathy Associated with RANBP2: Clinical and Therapeutic Implications in Pediatrics

Levine

Ahsan

et al. 2020

Multiple Sclerosis and Related Disorders

View full text Add to dashboard Cite

show abstract

“…A constellation of non-specific MRI findings have been reported in COVID-19 positive patients such as stroke and leptomeningeal enhancement, (9). Also a case of acute necrotizing encephalopathy (ANE) in a patient with COVID-19 has been reported so far, although it is not specific for COVID-19 (18). Specificity of MR findings will require a large number of cases from different centers across the world in patients and perhaps with RT-PCR positive for SARS-CoV-2 in the CSF.…”

Section: Discussionmentioning

confidence: 99%

Unusual lesion in the splenium of the corpus callosum and coronavirus infectious disease-19

Agarwal

Martini

Pedrotti

et al. 2020

Preprint

View full text Add to dashboard Cite

Coronavirus infectious diseases (COVID-19) is an emerging infectious disease that has taken a strong grip on the entire global community. The diagnosis per se is straightforward; however, the disease seems to affect multiple organs. Cytokine-storm, increased thromboembolic state, deranged overall homeostasis and aggressive medical treatment can cause a variety of lesions in the central nervous system. Interpretation of brain imaging findings will require a thorough understanding of the clinical status of the patient and treatment being offered, keeping in mind the several ways in which the viral pathogen, severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) may interact with brain tissue. We present differential diagnosis of a magnetic resonance imaging identified solitary lesion in the splenium of the corpus callosum, in a COVID-19 positive patient with altered mental status.

show abstract

“…Pathological findings include predominant involvement of the gray matter with white matter demyelination, perivascular lymphocytic cuffing, intracellular viral inclusions, neuronophagia, and gliosis (37).…”

Section: Subacute Sclerosing Panencephalitis (Sspe)mentioning

confidence: 99%

“…SSPE is a progressive measles virus mediated encephalitis that may present with brain MRI findings similar to a demyelinating disease. It is believed to be associated with an immature immune system and is seen in children with the onset of the primary infection in the first two years of life ( 37 ). On imaging, multifocal, bilateral but asymmetric lesions of the cortex and subcortical white matter are seen.…”

Section: What Are the Neuroradiological Mimics Of The Relapsing Demyementioning

confidence: 99%

Relapsing Demyelinating Syndromes in Children: A Practical Review of Neuroradiological Mimics

et al. 2020

View full text Add to dashboard Cite

Relapsing demyelinating syndromes (RDS) in children encompass a diverse spectrum of entities including multiple sclerosis (MS) acute disseminated encephalomyelitis (ADEM), aquaporin-4 antibody associated neuromyelitis optica spectrum disorder (AQP4-NMOSD) and myelin oligodendrocyte glycoprotein antibody disease (MOG-AD). In addition to these, there are "antibody-negative" demyelinating syndromes which are yet to be fully characterized and defined. The paucity of specific biomarkers and overlap in clinical presentations makes the distinction between these disease entities difficult at initial presentation and, as such, there is a heavy reliance on magnetic resonance imaging (MRI) findings to satisfy the criteria for treatment initiation and optimization. Misdiagnosis is not uncommon and is usually related to the inaccurate application of criteria or failure to identify potential clinical and radiological mimics. It is also notable that there are instances where AQP4 and MOG antibody testing may be falsely negative during initial clinical episodes, further complicating the issue. This article illustrates the typical clinico-radiological phenotypes associated with the known pediatric RDS at presentation and describes the neuroimaging mimics of these using a pattern-based approach in the brain, optic nerves, and spinal cord. Practical guidance on key distinguishing features in the form of clinical and radiological red flags are incorporated. A subsection on clinical mimics with characteristic imaging patterns that assist in establishing alternative diagnoses is also included.

show abstract

Neuroimaging of Emergent and Reemergent Infections

Cited by 39 publications

References 60 publications

Genetic Acute Necrotizing Encephalopathy Associated with RANBP2: Clinical and Therapeutic Implications in Pediatrics

Genetic Acute Necrotizing Encephalopathy Associated with RANBP2: Clinical and Therapeutic Implications in Pediatrics

Unusual lesion in the splenium of the corpus callosum and coronavirus infectious disease-19

Relapsing Demyelinating Syndromes in Children: A Practical Review of Neuroradiological Mimics

Contact Info

Product

Resources

About