Oztek Murat Alp,  Wright Jason,  Perez Francisco,  Khalatbari Hedieh,  Ishak Gisele

Final Pr. ID: Poster #: CR-028

Aseptic or chemical meningitis is an inflammation of the meninges without an infectious cause. It is a diagnosis of exclusion which is reached only in the appropriate clinical context after a careful search for bacterial or viral pathogens is negative. Aseptic meningitis following transsphenoidal resection of craniopharyngioma has been reported in the neurosurgical literature with an incidence of up to 3%; however, it remains unfamiliar in the radiology literature and there have been only a few case reports describing associated imaging findings. The chemical meningitis is thought to be caused by the release of craniopharyngioma fluid which contains inflammatory cholesterol crystals. Clinical and CSF findings can be identical to bacterial meningitis except for the absence of identifiable bacterial or viral pathogens. Complications can include vasospasm, stroke, and death. The purpose of this report is to describe two cases of aseptic meningitis following craniopharyngioma resection with the hope of improving awareness among pediatric radiologists. Read More

Authors:  Oztek Murat Alp , Wright Jason , Perez Francisco , Khalatbari Hedieh , Ishak Gisele

Keywords:  Craniopharyngioma, Meningitis, MRI

Jen Aaron,  Iskander Paul,  Ghahremani Shahnaz

Final Pr. ID: Poster #: CR-079

Case Report:
A 14 year-old previously healthy male presented to the emergency department with weakness, fever, diarrhea, lateral right eye deviation and transient vision loss, following a week of headaches and dizziness. The symptoms began following a recent camping trip to Yosemite National Park with friends, where distant contact with squirrels and several bug bites were noted. The initial physical examination revealed additional photophobia, limited neck flexion secondary to pain, and a raised, non-tender soft tissue mass over the anterior right shin. Soon after admission, the patient developed pain in the right hip and left leg and significant lower extremity weakness. A chest X-ray demonstrated left lower lobe consolidation, a left upper lobe lung nodule, and a right upper lobe lung nodule. MRI showed multifocal osteomyelitis and multiple intraosseous, intramuscular and soft tissue abscesses. Contrast-enhanced CT angiogram demonstrated septic emboli, scarring, and atelectasis within the left lower lung with a small hydropneumothorax. Lucent lesions were also noticed in the T3-T6 vertebral bodies with increased prominence of the paravertebral soft tissue.

A lumbar puncture was found consistent with bacterial meningitis. A blood culture, CSF culture, and culture of abscess fluid from the right hip were all found to be PCR positive for Yersinia pestis, and the patient was placed on a treatment regimen of ciprofloxacin, gentamicin, and tetracycline.

Discussion:
Plague, colloquial known as the Black Death, is a zoonosis caused by the gram-negative bacterium Yersinia pestis and endemic to the Western United States and developing countries. In the modern day, plague is typically found in infected rodents and spread to humans through fleas. Three forms of plague are reported in humans: bubonic, septicemic, and pneumonic. Our patient’s presented primary septicemic plague complicated by secondary pneumonia, meningitis, and osteomyelitis. Notably, Yersinia osteomyelitis has been reported only once in the historical literature, and was likely underappreciated before the advent of MRI. This case presentation will highlight the unique imaging manifestations of the patient’s disseminated disease. Read More

Authors:  Jen Aaron , Iskander Paul , Ghahremani Shahnaz

Keywords:  plague, osteomyelitis, pneumonia, meningitis, sepsis

Uncanin Nedeljko,  Kuzminski Christopher

Final Pr. ID: Poster #: CR-018

Parechovirus is generally asymptomatic in older children and can cause symptoms similar to that of the common cold. However, in infants less than 3 months, infection can be severe with seizures and sepsis-like presentations. Currently, there are no good treatments. Some providers have administered IVIG, but the efficacy is unknown. Most patients will recover with supportive care, however neonates can have long-term consequences. The Parechovirus A3 strain has been more prevalent in circulation over the summer of 2022, such that the Center for Disease Control and Prevention has issued a health alert about the unusually high prevlalence of the A3 strain in neonates and young infants. We present a case of meningoencephalitis with unique imaging findings on MRI with Parechovirus detection in CSF studies. Although few descriptions exist within the radiology literature, our case has MRI imaging characteristics are nearly identical to that of a case series published in the American Journal of Neuroradiology in August 2019. Given the increased prevalence of this virus and radiology findings consistent with the prior publication, the imaging findings on MRI can prove to be vital in assisting with the diagnosis of patients where CSF cannot be obtained. Read More

Authors:  Uncanin Nedeljko , Kuzminski Christopher

Keywords:  encephalitis, meningitis, parechovirus