Neuromelioidosis: Craniospinal MRI Findings in Burkholderia pseudomallei Infection
Neuromelioidosis: Craniospinal MRI Findings in Burkholderia pseudomallei Infection
复制标题
DOI：
10.1111/jon.12282
复制
发表时间：
2016-01-01
影响因子：
2.4
通讯作者：
Norton, Robert
中科院分区：
文献类型：
--
作者：
Hsu, Charlie Chia-Tsong;Singh, Dalveer;Norton, Robert
目的探讨中枢神经系统(CNS)假鼻疽伯克霍尔德氏菌感染的磁共振成像(MRI)表现。方法对10例经血、痰、脑脊液、脑活检和尸检证实的中枢神经系统类鼻炎患者进行回顾性分析。收集临床资料并独立复习MRI脑和/或脊柱。结果即使是脑实质或髓内病变的患者也表现出边缘强化的微脓肿，并倾向于白质束，包括皮质脊髓束、胼胝体和小脑脚。其中3例还表现为三叉神经增粗和强化，并向脑干三叉神经核团扩散。3例为孤立性轴外病变，表现为脑膜强化、硬膜外脓肿、颅骨骨髓炎和头皮脓肿。结论中枢神经系统类鼻炎的影像特征是微小脓肿沿白质束扩散和三叉神经频繁受累。这些发现可能为假单胞菌通过脑神经直接轴突运输绕过血脑屏障进入中枢神经系统提供了可能的机制。及时识别这种潜在致命感染的神经影像特征，可能有助于早期进行微生物培养和治疗。
PURPOSETo investigate magnetic resonance imaging (MRI) findings of central nervous system (CNS) infection with Burkholderia pseudomallei.METHODSRetrospective analysis of 10 patients (5 male and 5 female, age range from 13 to 69 years) with CNS melioidosis confirmed on culture of blood, sputum, cerebrospinal fluid, brain biopsy, and postmortem brain tissue. Clinical data were collected and MRI brain and/or spine were independently reviewed.RESULTSSeven patients with brain parenchymal or intramedullary spinal cord lesions demonstrated rim-enhancing microabscesses with propensity for white matter tracts including the corticospinal tracts, corpus callosum, and cerebellar peduncles. Three of these 7 patients also showed thickening and enhancement of the trigeminal nerves with contiguous spread to brain stem trigeminal nuclei. Three patients had isolated extraaxial disease with findings including meningeal enhancement, extradural abscess, skull osteomyelitis, and scalp abscess.CONCLUSIONSpread of microabscesses along white matter tracts and frequent trigeminal nerve involvement are unique imaging characteristics of CNS melioidosis. These findings may provide insight into potential mechanisms for B. pseuodomallei entry into the CNS through direct axonal transport in cranial nerves bypassing the blood brain barrier. Prompt recognition of the neuroimaging features of this potentially fatal infection may allow for early microbiological culture and treatment.