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MR Imaging of Acute Coccidioidal Meningitis

William K. ErlyGo,a, Richard J. Bellona, Joachim F. Seegera and Raymond F. Carmodya

a From the Department of Radiology, The University of Arizona, Tucson (W.K.E., J.F.S., R.F.C.); and the Department of Radiology, Stanford University Medical Center, Stanford, CA (R.J.B.).



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  		FIG 1. Life cycle of Coccidioides immitis.



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  		FIG 2. Case 7: 28-year-old woman.

A, Coronal contrast-enhanced T1-weighted image shows diffuse abnormal meningeal enhancement (arrow) along the course of the middle and anterior cerebral arteries. A shunt catheter (arrowheads) has been placed for acute hydrocephalus.

B, Axial T2-weighted image shows edema in the deep nuclei bilaterally (arrows). This is believed to represent areas of infarction/ischemia consequent to coccidioidal vasculitis.

FIG 3. Case 1: 36-year-old man. Findings on initial study were normal (not shown). Follow-up axial contrast-enhanced T1-weighted image 2 months later shows discrete nodules of abnormal enhancement (arrow) in the perimesencephalic cistern.



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  		FIG 4. Case 2: 22-year-old woman with disease progression.

A, Initial coronal contrast-enhanced T1-weighted MR image with focal enhancement in the left sylvian fissure (arrow).

B, Follow-up study 2 weeks later shows a new small focus of abnormal meningeal enhancement (arrow) on the medial aspect of the uncus.

C and D, Another week later, there is marked progression of disease to diffusely involve the basilar cisterns (arrows) as well as the course of the middle cerebral arteries (arrowheads).



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  		FIG 5. Case 4: 70-year-old man.

A, Unenhanced T1-weighted image shows abnormal soft-tissue mass in the ambient cistern (arrows).

B, Dense enhancement (arrowheads) is seen after administration of gadolinium chelate.



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  		FIG 6. Case 10: Low signal on T2-weighted images.

A, Axial T2-weighted image shows decreased signal (arrow) in the prepontine cistern.

B, Contrast-enhanced T1-weighted sequence shows marked enhancement (arrow) of the same area.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X