title: MR imaging of central nervous system Whipple disease: a 15-year review.
abstract: CNS WD is fatal if antibiotics are not begun early, but knowledge regarding the variety of presentations on MR imaging is limited. In order to more effectively recognize this entity on MR imaging, the Mayo Clinic medical records were reviewed for subjects diagnosed with CNS WD from 1992-2006 who had also undergone MR imaging of the neuraxis. Seven subjects were identified and their imaging findings were reviewed by the authors. Four of 7 had head MR imaging findings indicative of WD. Two subjects demonstrated high T2 signal within the corticospinal tracts. CNS WD may demonstrate high T2 signal with minimal enhancement and no restricted diffusion, primarily in the midline of the midbrain, hypothalamus, and mesial temporal lobes and occasionally the corticospinal tracts. MR imaging may also be normal. Radiologists should be aware of these presentations and be prepared to mention CNS WD as a diagnostic possibility since early antibiotic therapy may significantly impact morbidity and mortality.
authors.affiliation: Department of Radiology, Mayo Clinic Radiology, Rochester, MN 55905, USA. black.david@mayo.edu
authors.forename: D F
authors.initials: DF
authors.lastname: Black
authors.forename: A J
authors.initials: AJ
authors.lastname: Aksamit
authors.forename: J M
authors.initials: JM
authors.lastname: Morris
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology*; D005260:Female; D005682:Gadolinium; D006801:Humans; D007031:Hypothalamus / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008636:Mesencephalon / Q000473:pathology; D008875:Middle Aged; D011712:Pyramidal Tracts / Q000473:pathology; D012189:Retrospective Studies; D013702:Temporal Lobe / Q000473:pathology; D008061:Whipple Disease / Q000473:pathology*
chemical_list: D005682:Gadolinium
references.citation: Acta Neurochir (Wien). 2009 Feb;151(2):173-5
references.pmid: 19194653
references.citation: J Clin Neurosci. 1995 Apr;2(2):171-6
references.pmid: 18638806
references.citation: Scand J Gastroenterol. 2005 May;40(5):607-9
references.pmid: 16036516
references.citation: Ann Neurol. 1997 Jul;42(1):120-4
references.pmid: 9225695
references.citation: J Neurosurg. 2004 Aug;101(2):336-9
references.pmid: 15309928
references.citation: Gastroenterology. 1997 Aug;113(2):434-41
references.pmid: 9247461
references.citation: J Infect Dis. 2003 Sep 15;188(6):801-8
references.pmid: 12964110
references.citation: J Neuroimaging. 2007 Jan;17(1):81-3
references.pmid: 17238875
references.citation: N Engl J Med. 2007 Jan 4;356(1):55-66
references.pmid: 17202456
references.citation: Arch Neurol. 2005 Apr;62(4):618-20
references.pmid: 15824262
references.citation: J Infect Dis. 2003 Sep 15;188(6):797-800
references.pmid: 12964109
references.citation: Arch Neurol. 2009 Jan;66(1):130-1
references.pmid: 19139312
references.citation: AJNR Am J Neuroradiol. 1996 Sep;17(8):1589-91
references.pmid: 8883662
references.citation: Eur J Gastroenterol Hepatol. 1996 Sep;8(9):899-903
references.pmid: 8889458
references.citation: J Neurol Neurosurg Psychiatry. 1977 Sep;40(9):901-9
references.pmid: 74405
references.citation: Clin Neurol Neurosurg. 2008 Jan;110(1):83-7
references.pmid: 17923258
references.citation: Gastroenterology. 1985 Jun;88(6):1867-73
references.pmid: 2581843
references.citation: QJM. 2006 Sep;99(9):609-23
references.pmid: 16905752
references.citation: Ann Neurol. 1986 Dec;20(6):677-83
references.pmid: 2434019
references.citation: J Neurol Neurosurg Psychiatry. 2002 Sep;73(3):336-9
references.pmid: 12185176
references.citation: J Comput Assist Tomogr. 2005 May-Jun;29(3):320-2
references.pmid: 15891498
references.citation: AJNR Am J Neuroradiol. 1995 Jun-Jul;16(6):1328-9
references.pmid: 7545865