Brainstem Encephalitis Caused by Listeria monocytogenes

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.

Download Full-text

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

Acta Radiologica ◽

10.1177/0284185120943040 ◽

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.

Download Full-text

Rapidly progressive dementia due to neurosarcoidosis

Dementia & Neuropsychologia ◽

10.1590/s1980-57642013dn74000012 ◽

2013 ◽

Vol 7 (4) ◽

pp. 428-434

Author(s):

Gabriela Carneiro C. Fortes ◽

Marcos Castello B. Oliveira ◽

Laura Cardia G. Lopes ◽

Camila S. Tomikawa ◽

Leandro T. Lucato ◽

...

Keyword(s):

Correct Diagnosis ◽

Oral Prednisone ◽

Brain Biopsy ◽

High Dose ◽

Mri Findings ◽

Progressive Dementia ◽

Granulomatous Angiitis ◽

Severe Impairment ◽

Magnetic Resonance Imaging Mri ◽

One Year

ABSTRACT Rapidly progressive dementia (RPD) is typically defined as a cognitive decline progressing to severe impairment in less than 1-2 years, typically within weeks or months. Accurate and prompt diagnosis is important because many conditions causing RPD are treatable. Neurosarcoidosis is often cited as an unusual reversible cause of RPD. Methods: We report two cases of neurosarcoidosis presenting as RPD. Results: Case 1: A 61-year-old woman developed a RPD associated with visual loss. In seven months she was dependent for self-care. Magnetic resonance imaging (MRI) revealed temporal and suprasellar brain lesions. Treatment with high-dose intravenous prednisolone was associated with partial improvement. Case 2: A 43-year-old woman who was being treated for diabetes insipidus developed a severe episodic amnesia one year after onset of cognitive symptoms. Previous MRI had shown a hypothalamic lesion and she had been treated with oral prednisone and cyclophosphamide. There was reduction of the MRI findings but no improvement in the cognitive deficits. Brain biopsy disclosed noncaseous granulomas and granulomatous angiitis; treatment was changed to high-dose intravenous methylprednisolone, with poor symptomatic response. Conclusion: The diagnosis of RPD due to neurosarcoidosis can be challenging when the disease is restricted to the nervous system. In these cases, clinical presentation of RPD associated with neuroendocrine and visual dysfunction, imaging findings showing hypothalamic lesions and, in some cases, brain biopsy, are the key to a correct diagnosis. It is possible that earlier diagnoses and treatment could have led to a better outcome in these patients.

Download Full-text

Accessory and Cavitated Uterine Mass (ACUM) in an 18-Year-Old Woman: A Case Report and Literature Review

10.21203/rs.3.rs-1120568/v1 ◽

2022 ◽

Author(s):

HaiJing He ◽

XuZhi Liang ◽

Jiangtao Fan

Keyword(s):

Laparoscopic Surgery ◽

Medical Therapy ◽

Correct Diagnosis ◽

Clinical Manifestations ◽

Mullerian Anomaly ◽

Gynecological Disease ◽

Inflammatory Drugs ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

Benign Gynecological Disease

Abstract Background Accessory and cavitated uterine mass (ACUM) is a rare uterine anomaly newly recognized as a form of developmental Mullerian anomaly, which represents a non-communicating uterus-like mass within an otherwise normal uterus. It is a benign gynecological disease associated with severe dysmenorrhea and chronic pelvic pain, which is most common in young nullipara women, and sometimes develops in parous women. Clinical manifestations combined with imaging examinations including ultrasonography (USG), magnetic resonance imaging (MRI), and hysterosalpingography (HSG) are the means to establish a correct diagnosis. Medical therapy is only marginally effective, but laparoscopic surgery for complete mass excision is a feasible technique to relieve patient’s symptoms. Our article is aimed to report a case of ACUM in an 18-year-old woman and summarize the diagnostic criteria of ACUM. Case presentation : An 18-year-old woman was admitted for severe pain in the right lower abdomen during menstruation, which lasted more than 1 year. The patient was misdiagnosed with focal adenomyosis at our hospital on March 4, 2021. After 4 months, she was diagnosed with ACUM. Once diagnosis as focal adenomyosis, nonsteroidal anti-inflammatory drugs (NSAIDs) and gestrinone were administered to the patient. Following the diagnosis of ACUM, she received laparoscopic surgery. Our follow-up indicated that the symptom was significantly relief without drug therapy after sixty days postoperatively. Conclusions Clinical manifestations and imaging examinations are used to establish the diagnosis of ACUM. Medical therapy is only marginally effective, but laparoscopic surgery for complete mass excision is a feasible technique to solve the pain symptom. The prevalence and pathogenesis of ACUM and its reproductive outcomes on patients remain unclear, which calls for more and deeper research to study.

Download Full-text

Rapid detection of Listeria monocytogenes rhombencephalitis in an immunocompetent patient by multiplexed PCR

BMJ Case Reports ◽

10.1136/bcr-2018-225575 ◽

2018 ◽

pp. bcr-2018-225575 ◽

Cited By ~ 1

Author(s):

Rocco J Richards ◽

Matthew S Simon ◽

C Douglas Phillips ◽

Lindsay Lief ◽

Stephen G Jenkins ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Listeria Monocytogenes ◽

Cranial Nerve ◽

Rapid Detection ◽

Brain Mri ◽

Complete Recovery ◽

Immunocompetent Patient ◽

Brainstem Encephalitis ◽

Mri Findings ◽

Multiplexed Pcr

A 46-year-old previously healthy man presented with 1 week of headache, nausea, vomiting and dizziness. He was found to have cranial nerve deficits, his cerebrospinal fluid (CSF) demonstrated a lymphocytic pleocytosis and brain MRI suggested rhombencephalitis. Although Gram stains and cultures of his CSF did not identify a pathogen, Listeria monocytogenes DNA was detected by the FilmArray Meningitis/Encephalitis panel within 2 hours of performing a lumbar puncture. He was treated with ampicillin and gentamicin and had a near-complete recovery. This case highlights the importance of recognising L. monocytogenes infection as a cause of acute cranial nerve impairment with MRI findings suggestive of brainstem encephalitis. It also highlights the frequently atypical CSF profile and low yield of culture in L. monocytogenes rhombencephalitis and the value of multiplex PCR testing of CSF to rapidly identify this pathogen and permit targeted therapy.

Download Full-text

The Pitfalls of Febrile Jaundice. A Case Report

The Journal of Critical Care Medicine ◽

10.1515/jccm-2016-0013 ◽

2016 ◽

Vol 2 (2) ◽

pp. 93-95

Author(s):

Maria Obreja ◽

Andra Teodor ◽

Daniela Leca ◽

Alexandr Ceasovschih ◽

Egidia Miftode

Keyword(s):

Clinical Manifestations ◽

Multiple Organ ◽

Low Back ◽

Mri Findings ◽

Paravertebral Abscess ◽

Biliary Sepsis ◽

Inflammatory Processes ◽

Magnetic Resonance Imaging Mri ◽

Cholestatic Syndrome ◽

Febrile Jaundice

Abstract Jaundice in sepsis is usually caused by cholestasis, and its onset can precede other manifestations of the infection. Inflammation-induced cholestasis is a common complication in patients with an extrahepatic infection or those with inflammatory processes. We describe the case of a 47 years old female who presented with low back pain and paravertebral muscular contracture. She subsequently developed a cholestatic syndrome with clinical manifestations such as jaundice, followed by fever and sepsis with multiple organ dysfunction. Initially labeled as biliary sepsis, the diagnosis was crucially reoriented as the blood cultures were positive for Streptococcus pyogenes and the magnetic resonance imaging (MRI) findings suggested spondylodiscitis as well as a paravertebral abscess.

Download Full-text

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

Journal of International Medical Research ◽

10.1177/03000605211027442 ◽

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.

Download Full-text

Role of Diagnostic Imaging in Chronic Recurrent Multifocal Osteomyelitis (CRMO) in Children: An Observational Study

Children ◽

10.3390/children8090792 ◽

2021 ◽

Vol 8 (9) ◽

pp. 792

Author(s):

Michał Kopeć ◽

Magdalena Brąszewska ◽

Mariusz Jarosz ◽

Katarzyna Dylewska ◽

Andrzej Kurylak

Keyword(s):

Observational Study ◽

Clinical Symptoms ◽

Clinical Manifestations ◽

Chronic Recurrent Multifocal Osteomyelitis ◽

Conventional Radiography ◽

Cortical Layer ◽

Mri Findings ◽

Multifocal Osteomyelitis ◽

Magnetic Resonance Imaging Mri

The aim of this single-center observational study was to analyze the applicability of various imaging studies to the diagnosis and further evaluation of patients with chronic recurrent multifocal osteomyelitis (CRMO). The analysis included the data of 10 patients with CRMO treated between 2016 and 2021. The mean ages of the patients at the first manifestation of CRMO and ultimate diagnosis were 10 years and 7 months and 11 years and 10 months, respectively. Conventional radiography demonstrated focal loss of bone density in only 30% of the patients. Computed tomography showed disseminated foci with non-homogeneous osteolytic/osteosclerotic structure, with a massive loss of cortical layer and strong periosteal reaction. On magnetic resonance imaging (MRI), most patients presented with multifocal hypodense areas on T1-weighted images, with the enhancement of signal on T-weighted and STIR sequences. The duration of follow-up varied between 3 months and 3 years. In 40% of the patients, both clinical symptoms and the abnormalities seen on MRI resolved completely, whereas another 50% showed partial regression of clinical and radiological manifestations. MRI findings, co-existing with characteristic clinical manifestations, play a pivotal role in establishing the ultimate diagnosis of CRMO. MRI can also be used to monitor the outcomes of treatment in CRMO patients.

Download Full-text

Giant cavernous angioma of the temporal lobe: a case report and review of the literature

Acta Radiologica ◽

10.1080/02841850510012698 ◽

2005 ◽

Vol 46 (3) ◽

pp. 310-313 ◽

Cited By ~ 15

Author(s):

F. Gelal ◽

H. Feran ◽

T. Rezanko ◽

B. Dİrİm Vİdİnlİ

Keyword(s):

Temporal Lobe ◽

Degradation Products ◽

Correct Diagnosis ◽

Cavernous Angioma ◽

Mass Effect ◽

Vascular Lesions ◽

Mri Findings ◽

Cavernous Angiomas ◽

Imaging Appearance ◽

Magnetic Resonance Imaging Mri

Cavernous angiomas of the central nervous system are angiographically occult vascular lesions and are easily diagnosed by magnetic resonance imaging (MRI). Giant cavernous angiomas (GCA) are rare, with only 11 cases reported in the literature. Imaging appearance of GCAs has not been reviewed previously. We report a GCA of the temporal lobe, and discuss its computed tomography and MRI findings in the view of the literature. Imaging appearance of GCAs is variable. Some GCAs have features that are similar to those of typical cavernous angiomas, whereas some lesions may be purely cystic; and some present with significant contrast enhancement and mass effect, mimicking neoplasms. While the presence of hemosiderin, blood degradation products, and calcification may be helpful in the diagnosis of some cases, the correct diagnosis is not apparent until histopathological evaluation of the specimen is made in many instances.

Download Full-text

Clinical-radiological dissociation in a patient with nitrous oxide-induced subacute combined degeneration: A case report

10.21203/rs.2.494/v3 ◽

2020 ◽

Author(s):

Jiwei Jiang ◽

Xiuli Shang

Keyword(s):

Nitrous Oxide ◽

Vitamin B12 ◽

Clinical Symptoms ◽

Clinical Manifestations ◽

Serum Vitamin ◽

Mri Findings ◽

Subacute Combined Degeneration ◽

Posterior Aspect ◽

Magnetic Resonance Imaging Mri ◽

The One

Abstract Background: Several recent studies have reported subacute combined degeneration (SCD) induced by nitrous oxide (N2O) abuse. However, the association between the evolution of dynamic neuroimaging and clinical manifestations has not been reported in patients with N2O-induced SCD. Case presentation: We described the case of a 24-year-old man who developed SCD with inverted V-sign hyperintensities over the posterior aspect of the spinal cord caused by frequent, excessive N2O inhalation. One month after treatment, his weakness and paresthesia resolved and serum vitamin B12 levels exceeded the normal levels. However, the hyperintensities had extended horizontally and longitudinally on T2-weighted magnetic resonance imaging (MRI), compared to those on the initial scan. Two months after treatment, the patient experienced some residual numbness in the distal limbs, and his serum homocysteine levels were normal, but the abnormal signals seen on cervical T2-weighted MRI had decreased only slightly compared to those seen on the one-month follow-up MRI. The evolution of conventional MRI findings lagged compared to the clinical manifestation, which was suggestive of a clinical-radiological dissociation. Conclusions: Clinical-radiological dissociation might have occurred in this case because T2-weighted imaging was not sensitive enough to reveal cytotoxic edema. Moreover, the serum vitamin B12 level is not a good indicator of cellular vitamin B12. Thus, clinicians should recognize this phenomenon, comprehensively assess the condition of patients with N2O-induced SCD, and avoid terminating treatment based on the resolution of clinical symptoms and serological results.

Download Full-text

Diagnostic Accuracy of Preoperative Conventional MRI for Patients With Ectopic Pregnancy

International Surgery ◽

10.9738/intsurg-d-17-00117.1 ◽

2021 ◽

Vol 105 (1-3) ◽

pp. 449-454

Author(s):

Toshimichi Onuma ◽

Kimihisa Tajima ◽

Kumiko Sato ◽

Katsushige Hattori ◽

Shin Fukuda ◽

...

Keyword(s):

Ectopic Pregnancy ◽

Predictive Value ◽

Correct Diagnosis ◽

Tubal Pregnancy ◽

Mri Findings ◽

Tubal Ectopic Pregnancy ◽

Conventional Mri ◽

Mri Diagnosis ◽

Preoperative Magnetic Resonance ◽

Magnetic Resonance Imaging Mri

Objective To assess the utility of preoperative magnetic resonance imaging (MRI) in the diagnosis of tubal pregnancy. Summary of background data Most cases of ectopic pregnancy are tubal pregnancies. Preoperative accurate diagnosis including the location of the tubal pregnancy is important. Method We performed a retrospective single-center cohort study evaluating patients who underwent surgery for ectopic pregnancy from April 2004 to March 2016 and who underwent preoperative MRI. Sixty patients were enrolled in the study. Chorion confirmed at the tubal pregnancy site detected by MRI was defined as a correct diagnosis. Results Mean estimated gestational age at the time of MRI according to the last menstrual period was 7 weeks (median: 5 weeks; range: 3–10 weeks). Ectopic pregnancy was diagnosed by MRI in 57 cases, and all cases were either left or right tubal pregnancy. In 52 cases, the actual position matched the MRI findings. In 5 cases, the location of tubal ectopic pregnancy was different from that diagnosed by MRI, or no tubal pregnancy was observed intraoperatively. In 2 cases, no ectopic pregnancy site was observed on MRI, but tubal pregnancy was confirmed by surgery. In one case, an ectopic pregnancy site was not found, and the tube showed normal findings on MRI. The sensitivity of MRI diagnosis was 96.2%, specificity was 16.7%, positive predictive value was 91.1%, and negative predictive value was 33.3%. Conclusion In cases of ectopic pregnancy treated surgically, the sensitivity of MRI diagnosis, including identification of the location of ectopic pregnancy, is high.

Download Full-text