病毒性脑膜炎柯萨奇病毒课件

1,Case Discussion,Head and Neck,2,Sect 1: case discussion Sect 2: Radiology digest,3,History,Pulsated headache and dizziness for 2Ws occiput Temperature:37.5 cervical spondylosis with scorpion venom injection 1w before symptom,4,5,6,7,8,9,10,11,12,13,14,Diagnosis please,15,2008-11-20,16,17,18,19,2008-12-3,20,21,22,23,24,Definitions,Inflammatory infiltration of the pia mater, arachnoid,and CSF Commonly related to hematogenous dissemination from a distant infection Can be divided into acute pyogenic (bacterial),lymphocytic (viral), and chronic (TB) meningitis,25,General Imanging Features,Best diagnostic clue: Positive CSF by lumbar puncture Location: Subarachnoid space, pia enhance Morphology Smooth, intense leptomeningeal enhancement typical TB, fungal meningitis often basilar and confluent; may be nodular Imaging： normal early & findings nonspecific Imaging best delineates complications Hydrocephalus often occurs as early complication,26,CT Findings,NECT most commonly no abnormal fidings Mild ventricular enlargement Subarachnoid space enlargement Sulci & Basal cisterns effacement CECT Enhancing: exudate in sulci, cisterns Low density areas : perfusion alterations CTA: Arterial narrowing, occlusion,27,MR Findings,Tl WI: Exudate is isointense T2WI: Exudate is hyperintense FLAIR: Hyperintense signal in sulci, cisterns DWI Variable, may show restriction Most useful for vascular complications Tl C+: Exudate typically enhances MRA: Arterial narrowing, occlusion,28,Complications,Extraventricular obstructive hydrocephalus Ventriculitis, choroid plexitis Abscess, empyema, effusion Cerebrovascular complications (arteritis, infarct, venous thrombosis) Cerebral edema, infarction DWI useful in depicting perfusion alterations,29,Another case,Torulopsis neoformans,30,31,Another case,Klebsiella pneumoniae,32,33,DIFFERENTIAL DIAGNOSIS,34,Carcinomatous meningitis,Breast, lung most common distant primary tumors Primary CNS tumors include: GBM, medulloblastoma,pineal tumors, choroid plexus tumors Primary tumor often known,35,36,Neurosarcoidosis,Lacy leptomeningeal enhancement typical May have ventricular, dural based enhancing masses,spread of sarcoidosis granuloma along perivascular spaces,enhancement involving basilar cisterns, Sylvian fissures, and cortical sulci,enlargement of lateral ventricles enhancement in and adjacent to wall,diffuse thickening and enhancement of dura,37,Increased FLAIR signal in CSF,Subarachnoid hemorrhage (SAH) High inspired oxygen Acute stroke (parenchymal edema, vascular congestion) Artifact,38,Primary CNS lymphoma,Typically periventricular parenchymal disease Occasionally, lymphocytic meningitis,39,Gadolinium in CSF,Dialysis-dependent patient with end-stage renal disease Increased signal in CSF on T1WI and FLAIR,40,Thank You,Love God Love thy neighbor Jesus Christ,41,Material and Method,12 unrelated families 25 patients NOTCH3 mutation carriers 13 nonmutation carriers examined clinically standardized MR imaging baseline and after 7 years.,42,Material and Method,Progression measured semiquantitatively White matter hyperintensities (WMHs) lacunar infarcts microbleeding, brain volume loss,43,Material and Method,Software for Neuro-Image Processing in Experimental Research SNIPER intracranial volume determined after skull stripping Brain parenchyma and CSF were then segmented separately ventricular CSF volume and peripheral CSF volume,44,Material and Method,Final step, the WMHs were segmented Visual maps with summed distribution of all WMHs and lacunar infarcts throughout the brain in all of the mutation carriers segmentation masks normalized to a standardized brain shape,45,visual maps baseline and follow-up.,46,Conclusion,Patients with CADASIL who