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CNS Involvement of Virus-associated Hemophagocytic Syndrome: MR Imaging Appearance

Kirsten P.N. Forbesa, Donald A. CollieGo,a and Alistair Parkera

a From the Departments of Hematology (A.P.) and Neuroradiology (K.P.N.F., D.A.C.), Western General Hospital, Edinburgh, Scotland.



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  		FIG 1. Marrow aspirate of patient with virus-associated hemophagocytic syndrome (hematoxilin and eosin; original magnification, x100). Multiple macrophages (open arrows) show ingestion of erythrocytes and cell debris. In addition, one macrophage has ingested a nucleated white blood cell (black arrow)



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  		FIG 2. CNS involvement of viral-associated hemophagocytic syndrome.

A, Axial-view contrast-enhanced T1-weighted MR image of the cerebrum. Pial enhancement can be seen (black arrow). Additional enhancement of the Virchow-Robin perivascular spaces (open arrow) occurred because of extensive infiltration by lymphocytes and hemophagocytic histiocytes.

B and C, Sagittal-view contrast-enhanced T1-weighted MR images of the cervical cord. Enhancement of the Virchow-Robin perivascular spaces of the cervical cord white matter (open arrow) occurred because of extensive infiltration by lymphocytes and hemophagocytic histiocytes. Pial enhancement can be seen in the anterior cord (black arrow).

D, Axial-view contrast-enhanced T1-weighted MR image of the cervical cord at the C3 level. Enhancement of the white matter (open arrow) occurred because of extensive infiltration by lymphocytes and hemophagocytic histiocytes.

E, Axial-view T2-weighted MR image shows marked hyperintensity of the cerebellar hemispheres, presumed to be caused by secondary demyelination.

F, Axial-view T2-weighted MR image of the cerebrum shows that similar diffuse cerebral hemispheric white matter high signal changes are also present with no mass effect.





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