Severe complications such as meningoencephalitis are quite rare in the setting of mumps infection. We report here on a 24-year-old soldier with a past history of MMR vaccination who was admitted because of aseptic meningitis. His mental status rapidly deteriorated and swelling of both parotid glands was observed. The MR findings revealed discrete lesions in the brainstem and thalamus. He barely recovered within 2 months. Among the adults with failure to acquire immunity despite MMR vaccination, institutional crowding can lead to cases of potentially fatal CNS complication such as mumps meningoencephalitis.
Vaccination ; Mumps/*complications ; Meningoencephalitis/diagnosis/*etiology ; Measles-Mumps-Rubella Vaccine/*immunology ; Male ; Magnetic Resonance Imaging ; Humans ; Adult

BACKGROUNDAngiostrongyliasis cantonensis is a worldwide-existing parasitic disease. However, the relevant reports on its radiological appearances are limited. In this study, we investigated magnetic resonance imaging (MRI) features of eosinophilic meningoencephalitis in a group of consecutive patients caused by human infection with Angiostrongylus cantonensis after eating freshwater snails.

METHODSWe performed brain MR imaging on 74 patients with angiostrongyliasis cantonensis. The scanner was a 0.5T unit. For each patient MR pulse sequences of SE T1-weighted image (T1WI) and FSE T2-weighted image (T2WI) were used. After intravenous administration of gadolinium chelate (Gd-DTPA) repeated T1-weighted images were obtained. MRI features of the lesions in the brain and meninges were analyzed and recorded after observing initial and follow-up MR images. The classification of the types of angiostrongyliasis cantonensis infection was done on the basis of locations of the disorders.

RESULTSForty-one (55%) normal and 33 (45%) abnormal MRI appearances in the brain were found. According to locations of the disorders, the types of angiostrongyliasis cantonensis infection were determined as follows: seventeen cases of type meningitis, three of type myeloencephalitis, one of type neuritis and twelve of mixed type (eight of type ventriculitis and five of type pneumonitis were among them). In type meningitis, abnormal leptomeningeal enhancement was visualized. In type myeloencephalitis, lesions in the brain parenchyma may have iso- or slightly low signal intensity on T1WI and high signal intensity on T2WI. Enhanced nodules in various shapes were shown on gadolinium-enhanced T1WI, a few lesions appeared as crescent enhancements and some lesions did not reveal abnormal enhancement. Other than brain lesions, an enhanced nodule was seen in the cervical spinal cord in one patient. In type ventriculitis, brain ventricular enlargement was demonstrated. In type neuritis, a nodule and abnormal enhancement in the right optic nerve was revealed. In type pneumonitis, patchy ground-glass opacity and consolidative lesions at the periphery of the lungs were seen. Follow-up results indicated that most lesions in the brain could resolve in 2 to 8 weeks.

CONCLUSIONSAngiostrongyliasis cantonensis presented as both single type and mixed type. Nodular enhancing lesions in the brain and/or linear enhancement in the leptomeninges were the main findings, while crescent enhancement would be the characteristic sign of the disease on gadolinium-enhanced T1WI. Focal edematous changes without contrast enhancement in the brain could be seen on MRI in some cases.

Adolescent ; Adult ; Angiostrongylus cantonensis ; Animals ; Eosinophilia ; diagnosis ; etiology ; Female ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Meningoencephalitis ; diagnosis ; etiology ; Middle Aged ; Snails ; parasitology ; Strongylida Infections ; complications

Diagnosis, Differential ; Endophthalmitis ; diagnosis ; diagnostic imaging ; etiology ; pathology ; Humans ; Infant, Newborn ; Male ; Meningoencephalitis ; complications ; diagnosis ; diagnostic imaging ; pathology ; Suppuration ; Tomography, X-Ray Computed

OBJECTIVETo assess the diagnostic value of amplitude-integrated electroencephalography (aEEG) in predicting outcome of newborns who were at high risk for central nervous system without severe hypoxic-ischemic encephalopathy.

METHODSForty-two consecutive patients at risks for neurological disorders referred to our level-III NICU were prospectively enrolled in the study over a period of 3 years. They were classified on the basis of their primary diagnoses including hypoglycemic brain damage, meningoencephalitis, bilirubin encephalopathy, and metabolic disease. Clinical data were collected. Amplitude-integrated and raw EEG tracings were assessed for background pattern, sleep-wake cycling, and epileptiform activity. The neuromotor development of survivors was assessed by using the Infant Neurological International Battery (INFANIB).

RESULTThe characteristic of aEEG tracings in 42 infants showed continuous normal voltage (CNV)(n = 15), discontinuous voltage (DC)(n = 9), burst-suppression (BS) BS(+) (n = 6), BS(-)(n = 7), flat (FT, n = 5); mature sleep-wake cycling (SWC, n = 4), immature SWC (n = 14), no SWC (n = 24); 30 infants (71.4%) had electrical seizures: single seizure (n = 6); repetitive seizures (n = 7), and status epilepticus (SE) (n = 17).aEEG of 20 infants who had poor outcome showed FT (n = 5), BS(-)/SE (n = 6), BS(-)/ repetitive seizures (n = 1) , BS(+)/SE (n = 1), BS(+)/repetitive seizures (n = 1), DC/SE(n = 6). Chi-square analysis and Spearman rank correlation analysis showed the classification of aEEG background pattern, SWC and comprehensive score (score system was developed by evaluation of the above 3 variables) were correlated with the outcome of these infants at high neurological risks.

CONCLUSIONAmplitude-integrated electroencephalography can provide important information of the status of cerebral function in neonates at high neurological risk and help to predict their outcome.

Brain ; physiology ; physiopathology ; Brain Injuries ; diagnosis ; etiology ; physiopathology ; Electroencephalography ; methods ; Epilepsy ; diagnosis ; etiology ; physiopathology ; Humans ; Hypoglycemia ; complications ; Infant, Newborn ; Infant, Premature ; Intensive Care Units, Neonatal ; Kernicterus ; diagnosis ; physiopathology ; Meningoencephalitis ; diagnosis ; physiopathology ; Predictive Value of Tests ; Prognosis ; Sleep ; physiology