Question:

Regarding the imaging characteristics of B. mandrillaris meningoencephalitis, which is false?
1. Parenchymal lesions can involve the supra and infratentorial brain as well as the brainstem.
2. Central low T2 signal within parenchymal lesions is rare.
3. Enhancement of leptomeninges adjacent to parenchymal lesions is common.
4. Diffuse subarachnoid hemorrhage has been demonstrated late in the disease course.
5. Central blooming artifact on gradient echo imaging within parenchymal lesions suggest internal foci of hemorrhage and is commonly demonstrated.





Answer:

The correct answer for the question "Regarding the imaging characteristics of B. mandrillaris meningoencephalitis, which is false?" is:

2. Central low T2 signal within parenchymal lesions is rare.



Explanation
1. Parenchymal lesions have been demonstrated throughout the brain. [Initial MRI revealed innumerable poorly defined ring-enhancing lesions with surrounding edema bilaterally throughout the cerebral hemispheres with involvement of the brainstem, cerebellum, and right thalamus.]

2. Parenchymal lesions usually demonstrate low central T2 signal. [Many of these lesions again demonstrated central low T2 signal with associated blooming on GRE sequences, consistent with central foci of hemorrhage (fig 7).]

3. Adjacent leptomeningeal enhancement is common.[The consistent pattern of poorly defined ring enhancement and adjacent leptomeningeal enhancement with focus of central hemorrhage on radiological imaging should be especially viewed with caution as this may suggest fulminant angioinvasive GAE, particularly in the setting of recent solid organ transplantation.]

4. Diffuse subarachnoid hemorrhage has been demonstrated.  [He also developed diffuse subarachnoid hemorrhage, similar in appearance to what was seen in the donor bran imaging (fig 8).]

5. Signal changes suggestive of central hemorrhage, including blooming artifact on gradient echo imaging, are often seen within parenchymal lesions.  [Many of these lesions again demonstrated central low T2 signal with associated blooming on GRE sequences, consistent with central foci of hemorrhage (fig 7).]



From the manuscript:
Balamuthia Mandrillaris Meningoencephalitis associated with Solid Organ Transplantation - Review of Cases
Radiology Case. 2013 Sep; 7(9):9-18


This article belongs to the Neuro section.




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From the manuscript

Balamuthia Mandrillaris Meningoencephalitis associated with Solid Organ Transplantation - Review of Cases

Free full text article: Balamuthia Mandrillaris Meningoencephalitis associated with Solid Organ Transplantation -  Review of Cases

Abstract
We report the first identified transmission of Balamuthia mandrillaris through solid organ transplantation. Kidneys were transplanted from a donor with presumptive diagnosis of autoimmune encephalitis. Shortly after, the recipients developed neurologic symptoms. Magnetic Resonance Imaging of the brain from the donor and both kidney recipients demonstrated multiple ring enhancing lesions with surrounding edema and adjacent leptomeningeal extension. In addition most of the lesions demonstrated signal changes suggesting central hemorrhagic foci. Specimens were tested locally and at the Centers for Disease Control and Prevention. Histopathology revealed B. mandrillaris in either brain tissue and/or cerebral spinal fluid in the donor and recipients.






References



1. Matin A, Siddiqui R, Jayasekera S, Khan NA. Increasing Importance of Balamuthia mandrillaris. Clin Microbiol Rev 2008; 21(3): 435-448
Get full text
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2. Visvesvara GS, Martinez AJ, Schuster FL. Leptomyxid ameba, a new agent of amebic meningoencephalitis in humans and animals. J Clin Microbiol 1990; 28:2750--6
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


3. Denney C, Iragui V, Uber-Zak L. Amebic Meningoencephalitis Caused by Balamuthi and Review. Clin Infect Dis 1997; 25:1354-8
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


4. Diaz JH. The public health threat from Balamuthia mandrillaris in the southern United States. J La State Med Soc 2011 Jul-Aug;163(4):197-204
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


5. Orozco L, Hanigan W, Khan M, Fratkin J, Lee M. Neurosurgical Intervention in the Diagnosis and Treatment of Balamuthia mandrillaris Encephalitis J Neurosurg. 2011; 115(3): 636-640
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


6. Schlessinger S, Kokko K, Fratkin J. Balamuthia mandrillaris Transmitted Through Organ Transplantation - Mississippi, 2009. Morb Mortal Wkly Rep 2010;59(36):1165-1170
Get full text
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7. Glaser C, Schuster F, Yagi S. Balamuthia amebic encephalitis---California, 1999--2007. Morb Mortal Wkly Rep 2008;57:768--71
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


8. Deol I, Robledo L, Meza A, Visvesvara GS, Andrews RJ. Encephalitis due to a free living amoeba (Balamuthia mandrillaris): casereport with literature review. Surg Neurol 2000; 53:611-616
Get full text
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9. Bakardjiev A, Azimi PH, Ashouri N. Amoebic encephalitis caused by Balamuthia mandrillaris: report of four cases. Pediatr Infect
Get full text
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10. CDC, Notes from the Field: Transplant-Transmitted Balamuthia mandrillaris --- Arizona, 2010. Morb Mortal Wkly Rep 2010;59(36);1182.
Get full text
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