J Clin Neurol.  2019 Oct;15(4):575-577. 10.3988/jcn.2019.15.4.575.

Fulminant Cytotoxic Edema in a Patient with Pneumococcal Meningoencephalitis

• Alonso A
• Etminan N
• Krebs J
• Szabo K
• Platten M
• Förster A

• KMID: 2467771
• DOI: http://doi.org/10.3988/jcn.2019.15.4.575

Abstract

No abstract available.

MeSH Terms

Edema*
Humans
Meningoencephalitis*

Figure

• 

  Fig. 1 Fulminant cytotoxic edema in a patient with pneumococcal meningoencephalitis. DWI (A–E) demonstrate extensive symmetric areas in the white matter with restricted diffusion, including the external and internal capsule (A and B), the frontal and periventricular white matter sparing the cortex (B and C), the corona radiata (D) and the centrum semiovale (E). The lateral ventricles are filled with DWI-hyperintense debris, indicative of pyogenic ventriculitis (A). Areas with restricted diffusion are characterized by decreased signal in apparent diffusion coefficient maps (F–H), indicating cytotoxic rather than vasogenic edema. T2*-weighted images show focal subarachnoid hemorrhage in the right frontal and parietal lobe (I and J) and the left frontal lobe (J). On contrast-enhanced T1-weighted images, a slight enhancement of the leptomeninges at the convexity of the brain can be detected, but no disruption of the parenchymal blood-brain barrier (K). Areas with restricted diffusion exhibit hyperintense signal in FLAIR images (L and M). Time-of-flight angiography shows irregularities and multiple focal narrowing of proximal and distal intracranial arteries (arrows), suggesting vasculitis (N). DWI: diffusion-weighted image.

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