title: Leptomeningeal contrast enhancement and blood-CSF barrier dysfunction in aseptic meningitis.
abstract: OBJECTIVE
  To investigate the blood-CSF barrier (BCSFB) dysfunction in aseptic meningitis.
  
  
  METHODS
  In our case series of 14 patients with acute aseptic meningitis, we compared MRI characteristics with CSF findings.
  
  
  RESULTS
  Contrast enhancement in the sulcal space in a leptomeningeal pattern was visualized in 7 patients with BCSFB dysfunction categorized as moderate to severe as evidenced by the CSF/serum albumin ratio (Qalb) but was not present in those with mild or no barrier disturbance (p = 0.001). The Qalb as a marker for the leakiness of the BCSFB and, more indirectly, of the blood-brain barrier (BBB) was positively correlated with the incidence of leptomeningeal contrast enhancement seen on postcontrast fluid-attenuated inversion recovery (FLAIR) MRI (p = 0.003). Patients with a more pronounced brain barrier dysfunction recovered more slowly and stayed longer in the hospital.
  
  
  CONCLUSIONS
  The severity of meningeal BBB disturbance can be estimated on postcontrast FLAIR MRI, which may be of diagnostic value in patients with aseptic meningitis.
authors.affiliation: Department of Neurology (A.A., P.E., A.D.E., M.G., K.S., M.G.H., A.G.), Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany; and Theodor Kocher Institute (B.E.), University of Bern, Bern, Switzerland.
authors.forename: Angelika
authors.initials: A
authors.lastname: Alonso
authors.affiliation: Department of Neurology (A.A., P.E., A.D.E., M.G., K.S., M.G.H., A.G.), Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany; and Theodor Kocher Institute (B.E.), University of Bern, Bern, Switzerland.
authors.forename: Philipp
authors.initials: P
authors.lastname: Eisele
authors.affiliation: Department of Neurology (A.A., P.E., A.D.E., M.G., K.S., M.G.H., A.G.), Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany; and Theodor Kocher Institute (B.E.), University of Bern, Bern, Switzerland.
authors.forename: Anne D
authors.initials: AD
authors.lastname: Ebert
authors.affiliation: Department of Neurology (A.A., P.E., A.D.E., M.G., K.S., M.G.H., A.G.), Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany; and Theodor Kocher Institute (B.E.), University of Bern, Bern, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Griebe
authors.affiliation: Department of Neurology (A.A., P.E., A.D.E., M.G., K.S., M.G.H., A.G.), Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany; and Theodor Kocher Institute (B.E.), University of Bern, Bern, Switzerland.
authors.forename: Britta
authors.initials: B
authors.lastname: Engelhardt
authors.affiliation: Department of Neurology (A.A., P.E., A.D.E., M.G., K.S., M.G.H., A.G.), Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany; and Theodor Kocher Institute (B.E.), University of Bern, Bern, Switzerland.
authors.forename: Kristina
authors.initials: K
authors.lastname: Szabo
authors.affiliation: Department of Neurology (A.A., P.E., A.D.E., M.G., K.S., M.G.H., A.G.), Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany; and Theodor Kocher Institute (B.E.), University of Bern, Bern, Switzerland.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Hennerici
authors.affiliation: Department of Neurology (A.A., P.E., A.D.E., M.G., K.S., M.G.H., A.G.), Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany; and Theodor Kocher Institute (B.E.), University of Bern, Bern, Switzerland.
authors.forename: Achim
authors.initials: A
authors.lastname: Gass