scholarly journals Brucella prostatic abscess: a retrospective study of eight cases and a literature review

2021 ◽  
Vol 49 (9) ◽  
pp. 030006052110274
Author(s):  
Siqin Lan ◽  
Zhaoxing Guo ◽  
Yuanlin He ◽  
Wenya Liu ◽  
Hui Guo
Keyword(s):  
Clinical Manifestations ◽  
Mri Findings ◽  
Prostatic Abscess ◽  
Small Nodule ◽  
Reactive Protein ◽  
Hyperintense Signal ◽  
Laboratory Test Results ◽  
Prostate Enlargement ◽  
Magnetic Resonance Imaging Mri

Objective To present the clinical characteristics, diagnostics, and treatments for Brucella prostatic abscess (BPA). Methods We retrospectively analyzed eight BPA patients according to their vocations, age, clinical manifestations, laboratory test results, magnetic resonance imaging (MRI) findings, and treatments. Results The median age was 59 years. The most common clinical symptom was fever, followed by dysuria, erectile dysfunction, frequent urination, and urodynia. C-reactive protein (CRP) concentrations were significantly elevated in all patients, and in all by one patient, the erythrocyte sedimentation rate (ESR) was high. Prostate enlargement occurred in 87.5% of the patients. Lesions were located in the prostate peripheral (87.5%) and central zones (100%), with homogenous signals on T1-weighted imaging (T1WI) and a hyperintense signal on short tau inversion recovery (STIR). Patients had a small nodule or multiple nodules, with slight hyperintense to hyperintense signals on T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI). Three patients had pelvic effusion, and seminal vesicle (37.5%), epididymis (12.5%), and bladder (12.5%) infections occurred. All patients received rifampicin and doxycycline with levofloxacin; all lesions had resolved at follow-up ultrasonography. Conclusion Even in epidemic areas, the incidence of BPA is relatively rare. Our findings may increase the understanding of BPA and reduce misdiagnosis and mistreatment.

Diverse MRI findings and clinical outcomes of acute Marchiafava-Bignami disease

2020 ◽  
pp. 028418512094304
Author(s):  
Wei Li ◽  
Chao Ran ◽  
Jun Ma
Keyword(s):  
Clinical Outcomes ◽  
Clinical Manifestations ◽  
Acute Onset ◽  
Restricted Diffusion ◽  
Type I ◽  
Type Ii ◽  
Mri Findings ◽  
Type Iii ◽  
Mri Features ◽  
Magnetic Resonance Imaging Mri

Background The acute onset of Marchiafava-Bignami disease (MBD) is difficult to capture, and its clinical manifestations are overlapped. Magnetic resonance imaging (MRI) is very useful in the diagnosis of acute MBD. Purpose To investigate the MRI features and clinical outcomes of acute MBD. Materials and Methods Sagittal T2-weighted (T2W) or T1-weighted (T1W) imaging, axial T1W and T2W imaging, and axial FLAIR and diffusion-weighted imaging (DWI) sequences were performed in 17 patients with acute MBD on 1.5-T MR. According to the different ranges of callosal restricted diffusion, MBD was divided into Type I (n = 7, the completely involved), Type II (n = 5, the mostly involved), and Type III (n = 5, the partly involved). The MRI findings and outcomes of each type were retrospectively analyzed. Results With the reduced range of the callosal restricted diffusion, the callosal atrophy or cavitation was more common: no case of Type I; 1 (20%) case of Type II; and 3 (60%) cases of Type III. With the increased range of callosal restricted diffusion, the extracallosal involvement was more common: 6 (86%) cases of Type I; 3 (60%) cases of Type II; and 1 (20%) case of Type III. During the follow-up, five cases had neuropsychiatric sequelae: 1 (14%) case of type I; 1 (20%) case of Type II; 3 (60%) cases of Type III. Conclusion The MRI findings and clinical outcomes of acute MBD are regular. The extensive restricted diffusion of acute MBD may present the curable condition. Callosal heterogeneity may affect the outcome of acute MBD.

scholarly journals A case of chronic progressive Lyme encephalitis as a manifestation of late Lyme neuroborreliosis

2014 ◽  
Vol 6 (4) ◽  
Author(s):  
Vivek Verma ◽  
Matthew Roman ◽  
Disha Shah ◽  
Marina Zaretskaya ◽  
Mohamed H. Yassin
Keyword(s):  
White Matter ◽  
Short Term Memory ◽  
Treatment Options ◽  
Chronic Fatigue ◽  
Short Term ◽  
Mri Findings ◽  
White Matter Changes ◽  
Neurological Improvement ◽  
Magnetic Resonance Imaging Mri

A 54-year-old female living in Europe presented with gait ataxia, dizziness, and bilateral hearing loss. Magnetic resonance imaging (MRI) revealed non-specific white matter changes. The patient’s condition gradually deteriorated over two years without diagnosis. The patient continued to decline cognitively and neurologically with worsening ataxia and upper motor neuron signs. Repeat MRI showed worsening white matter changes. Lumbar puncture, not previously done, showed positive Lyme testing. Treatment with intravenous ceftriaxone resulted in marked neurological improvement. Four years after symptom, the patient has short-term memory deficits and chronic fatigue, but is otherwise neurologically, cognitively, and functionally intact. Follow up MRI findings remain largely unchanged. Because cases of intraparenchymal or encephalopathic neuroborreliosis in America are lacking, so are treatment options. We present a rare case and discuss our experience with antibiotic treatment. This case lends evidence to define optimal treatment of this disease, imperative for hastening neurological recovery.

The Syndrome of Spontaneous Intracranial Hypotension

Cephalalgia ◽  
1999 ◽  
Vol 19 (2) ◽  
pp. 80-87 ◽  
Author(s):  
CP O'Carroll ◽  
M Brant-Zawadzki
Keyword(s):  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Subdural Effusion ◽  
Resonance Imaging ◽  
Mri Findings ◽  
The Past ◽  
Downward Displacement ◽  
Prior Literature ◽  
Magnetic Resonance Imaging Mri

The authors report four cases of headache and other symptomatology related to the syndrome of intracranial hypotension. They were seen in a routine clinical practice over the past 3 years. The clinical features, magnetic resonance imaging (MRI) findings, and follow-up of these patients are described. Review of the prior literature on the topic is also included. All four patients presented with orthostatic headache syndrome. Three of the four demonstrated diffuse leptomeningeal thickening and enhancement on MRI studies. One subsequently developed a subdural effusion. One patient demonstrated downward displacement of the posterior fossa initially, which resolved on follow-up MRI scanning. Possible pathophysiologies of the syndrome are discussed.

scholarly journals Septic Hip Arthritis in Patients with Osteonecrosis of Femoral Head: Two Cases Report and Review of the Literature

2020 ◽  
Author(s):  
Zhiping Zhao ◽  
Xiangyu Wang ◽  
Changyao Wang ◽  
Yingzhen Wang ◽  
Yongtao Zhang
Keyword(s):  
Femoral Head ◽  
Septic Arthritis ◽  
Clinical Manifestations ◽  
Joint Fluid ◽  
Osteonecrosis Of Femoral Head ◽  
Reactive Protein ◽  
Intravenous Antibiotics ◽  
Hip Infection ◽  
Septic Focus ◽  
Magnetic Resonance Imaging Mri

Abstract Background: In patients with osteonecrosis of femoral head (ONFH), septic arthritis of the hip is rare, especially in the absence of factors likely to cause infection, which are often ignored by surgeons. Methods: Two patients seen at our hospital who had ONFH and concomitant septic arthritis of the hip joint were selected for inclusion in the study. Results: The clinical course suggests that ONFH developed prior to the hip infection. The two patients were not immune-compromised, and no remote septic focus was identified. The 2 patients, clinical manifestations of infection included fever and elevated white blood cell count. Elevated levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were observed in all 2 patients. In all patients, the results of hip magnetic resonance imaging (MRI) indicated hip infection. For 1 patients, culturing joint fluid revealed the presence of bacteria. In the second case, joint fluid was not cultured. In each case, the hip was debrided, and a spacer made of bone cement and containing vancomycin was implanted in the hip. Intravenous antibiotics were administered for 6 weeks postoperatively. There was no recurrence of infection, and total hip arthroplasty (THA) was performed 6 months after the operation. Conclusions: Septic hip is rare but exist in patients with ONFH. Elevated ESR and CRP contributed to the initial diagnosis; the results of hip MRI help to confirm the diagnosis. Overall, THA was an effective treatment.

Acute Cerebellitis or Postinfectious Cerebellar Ataxia? Clinical and Imaging Features in Acute Cerebellitis

2020 ◽  
Vol 35 (6) ◽  
pp. 380-388
Author(s):  
Mirac Yildirim ◽  
Rahsan Gocmen ◽  
Bahadir Konuskan ◽  
Safak Parlak ◽  
Dilek Yalnizoglu ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cerebellar Ataxia ◽  
Cerebellar Atrophy ◽  
Imaging Features ◽  
Resonance Imaging ◽  
Acute Cerebellitis ◽  
Hyperintense Signal ◽  
Magnetic Resonance Imaging Mri

Acute cerebellitis is a rare condition often considered within the group of acute postinfectious cerebellar ataxia despite its distinctive clinical and imaging features. We retrieved clinical, laboratory, and follow-up data of 15 children diagnosed with acute cerebellitis in our department between 2011 and 2019. There were 10 boys and 5 girls aged 3-15 years, median 9.5 years. The most common first symptoms were ataxia, vomiting, and headache. Magnetic resonance imaging (MRI) generally showed bilateral symmetrical T2 hyperintense changes with moderate swelling in the cerebellar cortex. Tonsillar herniation was present in 73.3% and obstructive hydrocephalus in 26.6%. Etiologic workup for infectious pathogens revealed Mycoplasma pneumoniae, influenza A virus, cytomegalovirus, and varicella zoster virus in 1 case each. Fourteen of 15 patients were treated with intravenous and/or oral steroids and 8 cases with intravenous immunoglobulin. No patient required surgical decompression. Neurologic examination median 12 months later revealed ataxia and dysmetria in 4 cases (27%), accompanied by memory difficulties, dysarthria or tremor. Follow-up magnetic resonance imaging (MRI; n = 12) showed diffuse cerebellar cortical T2-hyperintense signal changes in 11 cases and cerebellar atrophy in 9. The diagnosis of acute cerebellitis rather than acute postinfectious cerebellar ataxia should be considered when headache and vomiting accompany ataxia in a child. Acute cerebellitis heals with sequelae in about one-third of cases. The absence of fatalities in our series suggests early diagnosis, and steroid treatment can increase the chance of recovery. MRI results were not found to be predictive of outcome.

scholarly journals Brainstem Encephalitis Caused by Listeria monocytogenes

Pathogens ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. 715
Author(s):  
Pengxu Wei ◽  
Ruixue Bao ◽  
Yubo Fan
Keyword(s):  
Listeria Monocytogenes ◽  
Early Recognition ◽  
Correct Diagnosis ◽  
Clinical Manifestations ◽  
Good Health ◽  
Enteric Neurons ◽  
Brainstem Encephalitis ◽  
Mri Findings ◽  
Periodontal Tissues ◽  
Magnetic Resonance Imaging Mri

International outbreaks of listerial infections have become more frequent in recent years. Listeria monocytogenes, which usually contaminates food, can cause potentially fatal infections. Listerial cerebritis is a rare disease that is encountered mostly in immunocompromised or elderly patients. However, listerial brainstem encephalitis (mesenrhombencephalitis or rhombencephalitis) is found in persons who were formerly in good health, and recognizing this disease, particularly at its early stages, is challenging. Listerial brainstem encephalitis has high mortality, and serious sequelae are frequently reported in survivors. Early recognition and correct diagnosis, as well as the timely use of appropriate antibiotics, can reduce the severity of listerial infections. The trigeminal nerve is proposed as a pathway through which L. monocytogenes reaches the brainstem after entering damaged oropharyngeal mucosa or periodontal tissues. This review introduces the clinical manifestations, pathology, magnetic resonance imaging (MRI) findings, diagnosis, and treatment of listerial brainstem encephalitis. Moreover, it proposes that L. monocytogenes may also invade the brainstem along the vagus nerve after it infects enteric neurons in the walls of the gastrointestinal tract.

scholarly journals Pyomyositis of the pectineus muscle in an adolescent male

2017 ◽  
Vol 99 (7) ◽  
pp. e216-e218 ◽  
Author(s):  
J Hiddema ◽  
S Hassan ◽  
N Mangat ◽  
N Siddiqui
Keyword(s):  
White Cell Count ◽  
Normal Function ◽  
Adolescent Male ◽  
Reactive Protein ◽  
Intravenous Antibiotics ◽  
Tropical Areas ◽  
Widespread Availability ◽  
Magnetic Resonance Imaging Mri ◽  
Irritable Hip

The ‘irritable hip’ continues to pose a challenge for clinicians. Even with predictive clinical algorithms, decision making can be difficult. Emergency treatment is required if septic arthritis is suspected. Other differential diagnoses such as transient synovitis, pyomyositis of the pelvic girdle muscles and osteomyelitis must be considered in order to help guide appropriate investigations and allow early treatment. We report the case of a 13-year-old boy presenting to our institution with an acutely painful left hip but still able to weight bear. Despite a fever and raised inflammatory markers, the clinical examination did not correspond to that of an infected hip joint. Urgent magnetic resonance imaging (MRI) confirmed pyomyositis of the pectineus muscle. To our knowledge, this is the first reported case in the literature. The child was treated with seven days of intravenous antibiotics. There was a good clinical response as well as normalisation of the C-reactive protein level and white cell count. The patient was discharged home with a further week of oral antibiotics. Follow-up MRI at two weeks demonstrated a dramatic reduction in the inflammation of the pectineus. At the clinic follow-up appointment, the child was asymptomatic and back to normal function. Pyomyositis is typically found in tropical areas but its rates in temperate climates have been rising. It usually affects large groups of muscles such as the quadriceps and gluteal muscles. MRI is the gold standard investigation. If diagnosed early, the condition can be treated successfully with intravenous antibiotics alone. Given the widespread availability of MRI, we recommend its increased use to distinguish between pyomyositis and other paediatric hip pathologies.

New frontiers ahead focal therapy postoperative follow-up: What is the real role of MRI in this setting?

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. e539-e539
Author(s):  
Igor Nunes-Silva ◽  
Eric Barret ◽  
Mohammed Baghdadi ◽  
Victor Srougi ◽  
Silvia Garcia Barreras ◽  
...  
Keyword(s):  
Likelihood Ratio ◽  
Group Analysis ◽  
Focal Therapy ◽  
Primary Treatment ◽  
Matched Pair ◽  
Mri Findings ◽  
Predictive Values ◽  
Magnetic Resonance Imaging Mri ◽  
Sensitivity Specificity

e539 Background: Magnetic resonance imaging (MRI) plays an important role as a treatment-monitoring tool along focal therapy (FT) follow-up. This is the first study to assess MRI ability to correctly predict prostate cancer (PCa) local T-stage in the FT postoperative scenario. We aimed to describe MRI effectiveness in predicting upstaging in two groups of men: 1) men who failure after primary FT and then underwent salvage robotic-assisted radical prostatectomy (S-RARP) and 2) men who underwent RARP as primary treatment (P-RARP). Methods: Prospective data of 2775 men underwent RARP for localized PCa from 2000 to 2016 were reviewed. Twenty-two men underwent S-RARP after FT failure (S-RARP group). Total 2750 underwent RARP as first treatment. Matched-pair 1:2 selection of 44 out of 2750 patients by age defined primary RARP group (P-RARP). All patients underwent MRI immediately before RARP. MRI findings were confronted with final surgical pathology. Primary endpoint: sensitivity, specificity, positive and negative predictive values; positive (+LR) and negative (-LR) likelihood ratio regarding upstaging analysis on S-RARP. Secondary endpoint: same effectiveness analysis on P-RARP. Results: Preoperative MRI failed in predicting upstaging in 80% versus 91.7% of patients (p = 0.515) that presented final pathological status ≥ pT3a on S-RARP and P-RARP groups, respectively. On the other hand, when final pathology described a localized disease T2a-T2c, MRI correctly predicted the final pathological status in 81.8% versus 95.2% of patients (p = 0.27) on S-RARP and P-RARP groups, respectively. Between-group analysis, showed sensitivity and specificity rates of 20% versus 8.33% and 81.8% versus 95.23%, respectively; Positive and negative predictive values of 33.33% versus 50% and 69.23% versus 64.51%, respectively; Positive (+LR) and negative (-LR) likelihood ratio of 1.1 versus 1.74 and 0.98 versus 0.96, respectively. Conclusions: MRI has shown to be a weak diagnostic tool for predicting extra-prostatic disease along FT follow-up. Urologists may be warned about the risk of underdiagnosis and undertreatment in patients presenting failure after FT.

Pontine Tegmentum Lesions Accompanying Myelitis During an Enterovirus Outbreak: Differential Diagnosis and Outcome

2020 ◽  
Vol 35 (8) ◽  
pp. 501-508
Author(s):  
Mehmet Bastemur ◽  
Rahsan Gocmen ◽  
Safak Parlak ◽  
Deniz Yuksel ◽  
Elif Acar Arslan ◽  
...  
Keyword(s):  
Brain Mri ◽  
Prognostic Significance ◽  
Mri Findings ◽  
Acute Flaccid Myelitis ◽  
Pontine Tegmentum ◽  
Etiologic Agents ◽  
Spinal Mri ◽  
Polymerase Chain ◽  
Magnetic Resonance Imaging Mri

Aim: To investigate etiology and prognostic significance of pontine tegmentum lesions accompanying a cluster of acute flaccid myelitis. Method: We retrospectively examined patients from 6 centers in Turkey who manifested encephalitis or myelitis associated with dorsal pontine lesions on magnetic resonance imaging (MRI) between July 2018 and February 2019. Results: Twenty-two patients were evaluated. Ten of 22 (45%) presented with acute paralysis and 12 of 22 (55%) with brainstem symptoms only. Reverse transcription polymerase chain reaction for enterovirus was positive in 2 patients’ respiratory tract. Other etiologic factors were detected in 10 cases. On follow-up, patients presenting with symptoms of myelitis developed motor sequalae although spinal cord lesions on MRI resolved in 5 of 9 (55%). Encephalitic symptoms, present in 17 cases, recovered in 13 (76%), and brain MRI showed complete or near-complete resolution in 11 of 14 (78%). Conclusion: Various etiologic agents can be detected in patients with pontine involvement, even in a series collected during an outbreak of EV-D68. Encephalitis has a fair outcome but clinical recovery is slow and motor sequalae are frequent in spinal involvement, irrespective of follow-up spinal MRI findings.

scholarly journals MR imaging features of orbital Langerhans cell Histiocytosis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Chunnan Wu ◽  
Kuncheng Li ◽  
Yan Hei ◽  
Pengyu Lan ◽  
Xuetao Mu
Keyword(s):  
Mr Imaging ◽  
Diagnostic Accuracy ◽  
Langerhans Cell Histiocytosis ◽  
Clinical Manifestations ◽  
Langerhans Cell ◽  
Imaging Features ◽  
Mri Findings ◽  
Palpable Mass ◽  
Hyperintense Signal ◽  
Mri Features

Abstract Background To investigate the magnetic resonance imaging (MRI) features of orbital Langerhans cell histiocytosis (LCH) to improve diagnostic accuracy. Methods We retrospectively reviewed clinical manifestations and MRI findings of 23 patients with histopathology-confirmed LCH of the orbit. The findings were evaluated for the following: (a) symptoms, (b) disease duration, (c) location, (d) configuration, (e) margin, (f) MR imaging signal intensity and enhanced performance. Results Eighteen patients (78%) in our series were male, only five (22%) patients were female, and the mean age at presentation was 6.3 years. The common symptoms include swollen eyelids, exophthalmos, and a palpable mass. Fourteen patients presented with swollen eyelids and/or exophthalmos. Twenty-two cases involved unilateral orbits, and one case involved bilateral orbits. In our study, there was one patient with cough and expectoration, and one patient with polydipsia and polyuria. Lesions were located in the superior or superlateral orbital roof of seventeen patients (74%). Lesions formed masses or irregular shapes. The 12 out of 23 (52.2%) cases appeared heterogeneous isointense and 10 out of 23 (43.5%) cases showed iso-hypointense on T1-weighted imaging, there were 15 out of 23 (65.2%) cases showed hyper-hypointense mixed signals on T2-weighted imaging. 7 cases found patchy hyperintense signal on T1WI, and 11 cases showed markedly hyperintense signal near the edge of lesions on T2WI. After enhancement, 21 out of 23 (91.3%) cases lesions presented marked enhancement at the edges and the surrounding tissues, and with heterogeneous obvious enhancement of the lesion center. Besides, four cases lesions were surrounded by a low circular signal. Conclusion There were several characteristics MRI features that can provide crucial information for clinicians and improve our understanding and the diagnostic accuracy of the orbital LCH.

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