MR imaging of acute coccidioidal meningitis.
OBJECTIVE
Our purpose was to describe the MR imaging findings in patients with acute coccidioidal meningitis.


METHODS
Fourteen patients (11 men, three women; 22-78 years old; mean age, 47 years) with coccidioidal meningitis underwent neuroimaging within 2 months of diagnosis. Thirteen patients had MR imaging and one had an initial CT study with a follow-up MR examination 5 months later. Initial and follow-up MR images were evaluated for the presence of ventricular dilatation, signal abnormalities, enhancement characteristics, sites of involvement, and evidence of white matter or cortical infarction. The patterns of enhancement were characterized as focal or diffuse. Pathologic specimens were reviewed in two patients.


RESULTS
Ten of the 14 images obtained at the time of initial diagnosis showed evidence of meningitis. All of the initially abnormal studies showed enhancement in the basal cisterns, sylvian fissures, or pericallosal region. Subsequent studies, which were available for three of the four patients with normal findings initially, all eventually became abnormal, with focal enhancement seen on the initial abnormal examination. Other abnormalities seen at presentation included ventricular dilatation (six patients) and deep infarcts (four patients). Pathologic specimens in two patients showed focal collections of the organism corresponding to the areas of intense enhancement on MR images.


CONCLUSIONS
Early in its disease course, coccidioidal meningitis may show areas of focal enhancement in the basal cisterns, which may progress to diffuse disease. Pathologically, the areas of enhancement represent focal collections of the organism. Deep infarcts and communicating hydrocephalus are associated findings.
Erly
W K
WK
Department of Radiology, University of Arizona, Tucson 85724, USA.
Bellon
R J
RJ
Seeger
J F
JF
Carmody
R F
RF
D000208:Acute Disease; D000328:Adult; D000368:Aged; D001706:Biopsy; D002544:Cerebral Infarction / Q000175:diagnosis / Q000382:microbiology; D002552:Cerebral Ventricles / Q000382:microbiology / Q000473:pathology; D003047:Coccidioidomycosis / Q000175:diagnosis*; D003337:Corpus Callosum / Q000382:microbiology / Q000473:pathology; D004108:Dilatation, Pathologic / Q000175:diagnosis / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000382:microbiology; D007089:Image Enhancement / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D016921:Meningitis, Fungal / Q000175:diagnosis*; D008875:Middle Aged; D013702:Temporal Lobe / Q000382:microbiology / Q000473:pathology; D014057:Tomography, X-Ray Computed