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Diffuse Lesions in the CNS Revealed by MR Imaging in a Case of Whipple Disease

Stéphane Kremera, Gérard Bessona, Bruno Bonaza, Basile Pasquiera, Jean-F. Le Basa and Sylvie GrandGo,a

a From the Magnetic Resonance Imaging Unit (S.K., J.-F.L.B., S.G.) and the Departments of Neurology (G.B.), Hepato-Gastro-Enterology (B.B.), and Anatomopathology (B.P.), Centre Hospitalier et Universitaire de Grenoble, Hôpital Michallon, Grenoble, France.



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  		FIG 1. Images from the case of a 68-year-old man who was admitted for walking difficulties, memory loss, and incontinence that had been progressing for 5 months.

A, Axial T2-weighted MR image (4347/100/4) of the brain shows hyperintensity in the mediobasal part of the right and left temporal lobes (arrows), in the mamillary bodies (star), and in the optic chiasm (arrowhead).

B, Axial T2-weighted fluid-attenuated inversion recovery MR image (11000/140/2 [TR/TE/excitaitons]) of the brain shows diffuse hyperintensity involving the right mediobasal and left mediotemporal lobes (arrows), as well as involvement of the left cerebral peduncle (arrowhead). Note the lack of mass effect despite the size of the lesion.

C, Coronal fluid-attenuated inversion recovery MR image (11000/140/2) of the brain shows hyperintensity in the mediobasal part of right and left temporal lobes (arrows), brain stem (star), and right middle cerebellar peduncle (arrowhead).

D, Coronal T1-weighted MR image (535/14/2) of the brain shows mild enhancement of the right temporal lesions after the IV administration of a contrast agent (arrow).

E, Sagittal T2-weighted MR image (2745/120/6) of the spine shows hyperintensity in the central part of the spinal cord (arrow).

F, Coronal T2- weighted fluid-attenuated inversion recovery MR image (11000/140/2) of the brain, obtained after 1 year of treatment, shows nearly complete resolution of the right temporal lesion (arrow).



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  		FIG 2. Duodenal biopsy was performed. Note the characteristic foamy macrophages containing periodic acid-Schiff stain-positive rod-shaped structures in the submucosal region





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