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Type:
Educational Exhibit
Keywords:
CNS, Neuroradiology brain, Neuroradiology spine, MR, CT, MR-Diffusion/Perfusion, Diagnostic procedure, Contrast agent-intravenous, Haemorrhage, Infection, Tropical diseases
Authors:
K. Agawane, M. Bapat, M. R. Verma, D. P. Patkar, S. puranik; Mumbai/IN
DOI:
10.1594/ecr2016/C-1019
Findings and procedure details
CASE 1
A 41 years old male presented with fever since 3 days and sudden onset of unconsciousness since 1 day.
Clinical examination revealed petechiae all over his body.
On MRI,
we could see multiple T2 and FLAIR hyperintensities in bilateral cerebral hemispheres and involvement of corpus callosum.
Few areas appear hyperintense on T1 and show blooming on gradient (GRE) sequence (Figure 5).
His CSF was positive for dengue antibodies.
CASE 2
A 30 years old patient presented with fever and chills for 6 days followed by unconsciousness.
MRI brain was performed which shows multiple patchy T2 and FLAIR hyperintensities in bilateral basal ganglia,
pons and left parietal white matter.
(Figure 6)
These features were similar to viral encephalitis like Japanese encephalitis however his CSF picture came positive for dengue antibodies and thalami were relatively spared which is uncommon for Japanese encephalitis.
CASE 3
A 35 years old patient was brought by relatives in unconscious state which was of sudden onset.
There was history of fever with chills since 3 days.
His blood examination revealed thrombocytopenia,
leukopenia and elevated hematocrit levels.
Patient was taken to MRI of brain which revealed multiple foci of hemorrhages in bilateral cerebral and cerebellar hemispheres including deep grey matter nuclei appearing as blooming on susceptibility weighted images (SWI).
These foci were hyperintense on T2 and isointense on T1 weighted images.
(Figure 7)
CASE 4
A 29 years old patient from slum area came with complaints of high grade fever with generalized weakness and altered sensorium progressed to reduced consciousness and then he became comatose over a period of 6 days.
MRI showed bilateral near symmetric areas of white matter T2 hyperintensities in both cerebral hemispheres and few T2 hypointense foci are seen in bilateral basal ganglia and thalami which revealed blooming on SWI sequence suggestive of hemorrhages.
(Figure 8) These features are suggestive of hemorrhagic encephalitis.
Blood investigations were positive for dengue antibodies.
CASE 5
GUILLAIN-BARRE SYNDROME (GBS) - AN AUTOIMMUNE RESPONSE
A 39 years old patient came with history of flaccid paralysis of both lower limbs since 3 days.
He gave history of recent dengue fever 2 weeks ago.
MRI study of lumbar spine with intra venous contrast showed abnormal enhancement along nerve roots of cauda equina on post contrast T1 weighted images consistent with clinical diagnosis of GBS (Figure 9).