High-resolution vessel wall imaging in human neurocysticercosis with leptomeningitis

Imagens de alta resolução das paredes dos vasos na neurocisticercose humana, com leptomeningite

The high-resolution vessel wall imaging (HR-VWI) is a millimetric technique that demonstrates vessel wall inflammation, which can occur simultaneously with leptomeningitis. Encephalic infarction may be observed in less than 50% of the cases.¹, ², ³

A 42-year-old man with neurocysticercosis, presented headache and visual blurring. Magnetic resonance imaging (MRI) and HR-VWI scans were performed, as demonstrated in ►Figures 1 and 2, respectively. The findings contribute to the pathophysiology of the disease, by demonstrating concentric and irregular wall enhancement (vasculitis). The degree of vessel involvement correlates with the severity of disease stage,¹ and was demonstrated in other infections, such as syphilis,⁴ and tuberculosis,¹,⁵ but not in neurocysticercosis.

Figure 1
Axial Fast Imaging Employing Steady-state Acquisition (FIESTA) images (A and B): cystic lesions in the subarachnoid space. Axial T1 post-contrast (C and D): a nodular lesion with peripheral contrast enhancement in the left calcarine region (arrow) and leptomeningeal enhancement (arrowhead). The MIP axial TOF MRA and DWI images (E and F) showed no significant abnormalities. Abbreviations: DWI, Diffusion-weighted imaging; MIP, Maximum Intensity Projection; MRA, Magnetic Resonance Angiography; TOF, Time-Of-Flight.

Figure 2
Axial HR-VWI pre (A) and post-contrast (B) demonstrate smooth enhancement in both M1 middle cerebral arteries.

References

• ¹
  Choudhary N, Vyas S, Modi M, et al. MR vessel wall imaging in tubercular meningitis. Neuroradiology 2021;63(10):1627–1634
• ²
  Pacheco FT, Cruz Junior LCHD, Padilha IG, et al. Current uses of intracranial vessel wall imaging for clinical practice: a high-resolution MR technique recently available. Arq Neuropsiquiatr 2020;78(10):642–650
• ³
  Mont’Alverne Filho FE, Machado LdosR, Lucato LT, Leite CC. The role of 3D volumetric MR sequences in diagnosing intraventricular neurocysticercosis: preliminar results. Arq Neuropsiquiatr 2011;69(01):74–78
• ⁴
  Feitoza LM, Stucchi RSB, Reis F. Neurosyphilis vasculitis manifesting as ischemic stroke. Rev Soc Bras Med Trop 2020;53: e20190546
• ⁵
  Feitoza LM, Jarry VM, Ramos MC, Reis F. High-Resolution Vessel Wall MRI as a Complementary Investigation for CNS Tuberculosis. Can J Neurol Sci 2021;48(05):717–718

Publication Dates

• Publication in this collection
  21 Nov 2022
• Date of issue
  July 2022

History

• Received
  17 Jan 2022
• Accepted
  07 Mar 2022