Role of MR spectroscopy in diagnosis of intracranial neuroenteric cyst

Phadke, Rajendra V.; Naik, Suprava; Udiya, Alok; Shetty, Gurucharan S; Singh, Vivek; Bhoi, Sanjeev Kumar

doi:10.1007/s00381-018-3802-1

Cited by 4 publications

(5 citation statements)

References 6 publications

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“…The loss of the NAA peak, indicating loss of neuronal integrity, coupled with increased choline (Cho) levels, is consistent with gliomas [5]. Conversely, neurenteric cysts, lined by pseudostrati ed columnar epithelium and containing mucin-secreting goblet cells, may show varying mucinous content with NAA-like metabolite peaks similar to glycoprotein-containing cystic lesions [4]. Additional metabolites, such as lactate peaks, present in anaerobic metabolism, can aid in distinguishing ischemia, infection, and some high-grade gliomas [5].…”

Section: Discussionmentioning

confidence: 74%

“…Despite various differential diagnoses for cystic lesions with NAA-like peaks, the combination of conventional MRI descriptions and spectroscopy aids in diagnosis [4]. In this case, the cystic lesion exhibited an NAA-like peak suggesting mucinous content, with low lactate and lipid components, indicating a non-infectious origin.…”

Section: Discussionmentioning

confidence: 83%

“…Distinguishing central nervous system tuberculomas from neurenteric cysts in the posterior fossa is clinically and radiologically challenging since they have overlapping MRI ndings. Tuberculomas' MRI appearances may vary with the disease stage [3], while neurenteric cyst contents in uence their appearances on conventional MRI [4]. Both entities may exhibit hypointense T2 signals.…”

Section: Discussionmentioning

confidence: 99%

“…The normal NAA levels further ruled out gliomas. The ventral cerebellopontine angle location, absence of restricted diffusion, magnetic susceptibility artifacts, calci cation, and bony erosions, made other cystic differential diagnoses less likely [4].…”

Section: Discussionmentioning

confidence: 99%

“…The closest non-invasive method of diagnosis would be neuroimaging especially when faced with a dilemma and lacking histology for guidance. Although MRI with spectroscopy is not a perfect tool as appearances of cysts may vary depending on its content [4]…”

Section: Discussionmentioning

confidence: 99%

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Magnetic resonance spectroscopy (MRS) as an aid to diagnose a ruptured neurenteric cyst mimicking infectious meningitis- a case report

Ty,

Separa,

Baladjay

et al. 2024

Preprint

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Introduction Neurenteric cysts are rare neoplasms from aberrant developmental endodermal tissues linked to the notochord that form later in life as midline masses, mainly in the brainstem and spinal cord. Few case reports documented meningitis associated with these cysts, but none describe how MRS can aid in diagnosing this rare condition when it overlaps clinically with infectious meningitis. Case presentation We report a case of a 22-year-old male with a family exposure to tuberculosis and multiple male sexual partners, presented with a two-week history of fever, headache, neck pain, progressive leg numbness, progressing to paralysis, alongside mental slowing, vision deterioration, and focal seizures a few days before admission. He had normal blood pressure and tachycardia but remained oriented and responsive. Physical examination revealed no light perception, sluggish pupillary reaction, cranial nerve abnormalities on the right side, reduced reflexes, paraplegia, and nuchal rigidity. Initial imaging showed hydrocephalus, basal enhancement, and right cerebellopontine mass, thus managed as tuberculous meningitis with tuberculoma and underwent surgery. The infectious work-up was negative for both cerebrospinal fluid and blood. Magnetic resonance spectroscopy (MRS) showed NAA-like peaks, and the absence of lipid-lactate peaks was consistent with neurenteric cysts. Further surgery was no longer feasible as the patient deteriorated with sepsis and succumbed to brainstem compression. Conclusion This case underscores the importance of knowing rare and atypical presentations, such as ruptured neurenteric cysts causing chemical meningitis presenting as more common infectious meningitis and the utility of MRS in helping narrow down the differential diagnoses and clinching the diagnosis.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 83%