ABSTRACT
BACKGROUND AND PURPOSE: Influenza A infection can precipitate encephalopathy, encephalitis, or Reye syndrome with the development of cerebral edema in children and is associated with an increased incidence of stroke in adults. The mechanism of these events is poorly understood. Posterior reversible encephalopathy syndrome (PRES) is seen in association with infection/sepsis, and cerebral vasculopathy has been demonstrated in PRES. We describe a case of PRES that develops in association with influenza A. SUMMARY OF CASE: A normotensive 65-year-old woman presented with altered mentation and nausea in the setting of a viral prodromal illness ultimately confirmed as influenza A. Posterior reversible encephalopathy syndrome developed on the second day after admission. Catheter cerebral angiogram documented vasculopathy in PRES-involved regions with areas of focal vessel dilatation and string-of-bead appearance. CONCLUSIONS: The association between influenza A and PRES with documentation of cerebral vasculopathy suggests a common systemic vascular mechanism behind PRES and influenza-related encephalopathic edema and stroke.
Subject(s)
Cerebrovascular Disorders/etiology , Hypertensive Encephalopathy/etiology , Influenza A virus/isolation & purification , Influenza, Human/complications , Aged , Cerebral Angiography , Cerebrovascular Disorders/diagnosis , Female , Humans , Hypertensive Encephalopathy/diagnosis , Influenza, Human/diagnosis , Magnetic Resonance Imaging , Syndrome , Tomography, X-Ray ComputedABSTRACT
Endoscopic surgery using an expanded endonasal approach now allows surgical access to an increasing range of parasellar, suprasellar, clivus, and petrous apex lesions. Accurate preoperative planning requires proper interpretation of CT and MRI results. It is essential to identify important anatomic landmarks and to recognize the appearance of common lesions and pseudolesions. Postoperative imaging must evaluate for residual tumors and identify iatrogenic conditions.
Subject(s)
Bone Diseases/diagnosis , Cavernous Sinus/pathology , Cerebrovascular Disorders/diagnosis , Petrous Bone/pathology , Aneurysm/diagnosis , Brain Diseases/diagnosis , Cavernous Sinus/innervation , Humans , Magnetic Resonance Imaging/methods , Meningioma/diagnosis , Petrous Bone/blood supply , Pituitary Neoplasms/diagnosis , Skull Base/pathology , Skull Neoplasms/diagnosis , Tomography, X-Ray Computed/methodsABSTRACT
In a retrospective review, 3 (3.8%) of 78 patients developed recurrent posterior reversible encephalopathy syndrome. Underlying clinical conditions included sickle cell disease, antibody-positive autoimmune disease, and allogeneic bone marrow transplantation. Infection (bacterial/viral) was suspected or documented in both episodes in all 3 patients. Evidence of endothelial injury (schistocyte formation and increased lactate dehydrogenase) was documented in all patients, and multiple organ dysfunction syndrome developed during the hospital course of all admissions.
Subject(s)
Brain Edema/diagnosis , Multiple Organ Failure/diagnosis , Adult , Female , Humans , Magnetic Resonance Imaging , Middle Aged , Recurrence , Retrospective Studies , Syndrome , Tomography, X-Ray ComputedABSTRACT
INTRODUCTION: The purpose of this study was to compare the differences in gland enhancement, microlesion enhancement and gland-lesion contrast ratio in patient groups in which half-dose (HD), standard-dose (SD) and double-dose (DD) contrast medium was used in pituitary MR imaging. METHODS: Pituitary gland enhancement and microlesion enhancement were measured and gland-lesion contrast ratios were calculated in 18 patients receiving HD (0.05 mmol/kg), 9 receiving SD (0.1 mmol/kg) and 13 receiving DD (0.2 mmol/kg) contrast medium. Gland enhancement and microlesion enhancement over baseline were determined employing DICOM region of interest measurements and compared after normalization to temporal lobe white matter. Contrast ratios and differences were also calculated and compared. RESULTS: Gland enhancement and lesion enhancement were greater with larger contrast medium doses (gland: HD 50%, SD 99%, DD 132%; microlesion: HD 19%, SD 54%, DD 86%). The gland-lesion contrast ratios were similar with the three doses (25.6%), reflecting expected similar fractional contrast medium distributions in spite of different doses. The signal difference between gland and microlesion, therefore, was a fixed percentage of gland enhancement (DeltaS approximately 26%) with greater signal differences with larger contrast medium doses. CONCLUSION: Greater gland-to-lesion signal differences with larger contrast medium doses would likely improve pituitary microlesion visualization and margin characterization aiding in microlesion detection as well as preoperative planning.
