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Use of Radiologic Modalities in Coccidioidal Meningitis

Use of Radiologic Modalities in Coccidioidal Meningitis Abstract • The diagnostic utility of pentetate indium trisodium In 111 CSF studies, technetium Tc 99m brain scans, and computerized tomographic (CT) scans was evaluated in eight patients in whom coccidioidal meningitis developed following a dust storm in the Central Valley of California. The 111In flow studies and the CT scans demonstrated hydrocephalus in five patients with clinical findings suggesting this complication. Ventriculitis has not previously been diagnosed before death in patients with coccidioidal meningitis; however, it was demonstrated in two patients by the technetium Tc 99m brain scan. Basal meningitis, which is indicative of fungal infection, is also detectable on contrastenhanced CT scan. The finding that communicating hydrocephalus occurs early in meningitis and interferes with CSF flow into infected basilar regions has important therapeutic implications in that antifungal agents injected into the lumbar subarachnoid space may not reach these regions. (Arch Intern Med 141:75-78, 1981) References 1. Goldstein E, Lawrence RM: Coccidioidomycosis of the central nervous system , in Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology: III. Infections of the Nervous System , ed 3. Amsterdam, North Holland Publishing Co, 1978, p 443. 2. McCullough DC, Harbert JC: Isotope demonstration of CSF pathways: Guide to antifungal therapy in coccidioidal meningitis. JAMA 209:558-560, 1969.Crossref 3. Corbus GF, Lippert RG, Radding J: Radionuclide studies in coccidioidal meningitis. West J Med 125:320-325, 1976. 4. Drutz DJ, Catanzaro A: Coccidioidomycosis. Am Rev Respir Dis 117:727-771, 1978. 5. Pappagianis D, Crane R: Survival in coccidioidal meningitis since introduction of amphotericin B coccidioidomycosis , in Ajello L (ed): Current Clinical and Diagnostic Status . Miami, Symposia Specialists, 1977, p 223. 6. Jenkins VE, Postlewaite JC: Coccidioidal meningitis: Report of four cases with necropsy findings in three cases. Ann Intern Med 35:1068-1084, 1951.Crossref 7. Salmon JH: Ventriculitis complicating meningitis. Am J Dis Child 124:35-40, 1972. 8. Lee HK: Unilateral pyogenic ventriculitis. J Nucl Med 18:403, 1977. 9. Daly NJ, Patton DD: Ventriculitis: Diagnosis with technetium-99m DTPA. J Nucl Med 19:1233-1234, 1978. 10. Fulmer LR, Stakienakis GN: Cerebral ventricle visualization during brain scanning with 99mTc-pertechnetate. J Nucl Med 15:202-204, 1974. 11. Weisberg LA: Computed tomography in the diagnosis of intracranial disease. Ann Intern Med 91:87-105, 1979.Crossref 12. Flynn NM, Hoeprich PD, Kawachi MM, et al: An unusual outbreak of windborne coccidioidomycosis. N Engl J Med 301:358-361, 1979.Crossref 13. James AE Jr, Sperber E, Strecker E-P, et al: Use of serial cisternograms to document dynamic changes in the development of communicating hydrocephalus: A clinical and experimental study. Acta Neurol Scand 50:153-170, 1974.Crossref 14. Lewis SE, Hickey DC, Parkey RW: Radionuclide brain imaging: Its role and relation to CT scanning. Comput Tomogr 2:155-172, 1978.Crossref 15. James AE Jr: Cerebrospinal fluid imaging (cisternography) , in Robbins LL (ed): Golden's Diagnostic Radiology . Baltimore, Williams & Wilkins Co, 1976, p 303. 16. Strecker E-P, James AE Jr: Evaluation of the changes of cerebrospinal fluid movement associated with meningitis: A cisternographic analysis. AJR 118:147-154, 1973.Crossref 17. Gilday DL: Various radionuclide patterns of cerebral inflammation in infants and children. AJR 120:247-253, 1974.Crossref 18. Carpenter MB: Meninges and cerebrospinal fluid , in Human Neuroanatomy , ed 7. Baltimore, Williams & Wilkins Co, 1976, p 1. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Use of Radiologic Modalities in Coccidioidal Meningitis

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Publisher
American Medical Association
Copyright
Copyright © 1981 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1981.00340010067015
Publisher site
See Article on Publisher Site

Abstract

Abstract • The diagnostic utility of pentetate indium trisodium In 111 CSF studies, technetium Tc 99m brain scans, and computerized tomographic (CT) scans was evaluated in eight patients in whom coccidioidal meningitis developed following a dust storm in the Central Valley of California. The 111In flow studies and the CT scans demonstrated hydrocephalus in five patients with clinical findings suggesting this complication. Ventriculitis has not previously been diagnosed before death in patients with coccidioidal meningitis; however, it was demonstrated in two patients by the technetium Tc 99m brain scan. Basal meningitis, which is indicative of fungal infection, is also detectable on contrastenhanced CT scan. The finding that communicating hydrocephalus occurs early in meningitis and interferes with CSF flow into infected basilar regions has important therapeutic implications in that antifungal agents injected into the lumbar subarachnoid space may not reach these regions. (Arch Intern Med 141:75-78, 1981) References 1. Goldstein E, Lawrence RM: Coccidioidomycosis of the central nervous system , in Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology: III. Infections of the Nervous System , ed 3. Amsterdam, North Holland Publishing Co, 1978, p 443. 2. McCullough DC, Harbert JC: Isotope demonstration of CSF pathways: Guide to antifungal therapy in coccidioidal meningitis. JAMA 209:558-560, 1969.Crossref 3. Corbus GF, Lippert RG, Radding J: Radionuclide studies in coccidioidal meningitis. West J Med 125:320-325, 1976. 4. Drutz DJ, Catanzaro A: Coccidioidomycosis. Am Rev Respir Dis 117:727-771, 1978. 5. Pappagianis D, Crane R: Survival in coccidioidal meningitis since introduction of amphotericin B coccidioidomycosis , in Ajello L (ed): Current Clinical and Diagnostic Status . Miami, Symposia Specialists, 1977, p 223. 6. Jenkins VE, Postlewaite JC: Coccidioidal meningitis: Report of four cases with necropsy findings in three cases. Ann Intern Med 35:1068-1084, 1951.Crossref 7. Salmon JH: Ventriculitis complicating meningitis. Am J Dis Child 124:35-40, 1972. 8. Lee HK: Unilateral pyogenic ventriculitis. J Nucl Med 18:403, 1977. 9. Daly NJ, Patton DD: Ventriculitis: Diagnosis with technetium-99m DTPA. J Nucl Med 19:1233-1234, 1978. 10. Fulmer LR, Stakienakis GN: Cerebral ventricle visualization during brain scanning with 99mTc-pertechnetate. J Nucl Med 15:202-204, 1974. 11. Weisberg LA: Computed tomography in the diagnosis of intracranial disease. Ann Intern Med 91:87-105, 1979.Crossref 12. Flynn NM, Hoeprich PD, Kawachi MM, et al: An unusual outbreak of windborne coccidioidomycosis. N Engl J Med 301:358-361, 1979.Crossref 13. James AE Jr, Sperber E, Strecker E-P, et al: Use of serial cisternograms to document dynamic changes in the development of communicating hydrocephalus: A clinical and experimental study. Acta Neurol Scand 50:153-170, 1974.Crossref 14. Lewis SE, Hickey DC, Parkey RW: Radionuclide brain imaging: Its role and relation to CT scanning. Comput Tomogr 2:155-172, 1978.Crossref 15. James AE Jr: Cerebrospinal fluid imaging (cisternography) , in Robbins LL (ed): Golden's Diagnostic Radiology . Baltimore, Williams & Wilkins Co, 1976, p 303. 16. Strecker E-P, James AE Jr: Evaluation of the changes of cerebrospinal fluid movement associated with meningitis: A cisternographic analysis. AJR 118:147-154, 1973.Crossref 17. Gilday DL: Various radionuclide patterns of cerebral inflammation in infants and children. AJR 120:247-253, 1974.Crossref 18. Carpenter MB: Meninges and cerebrospinal fluid , in Human Neuroanatomy , ed 7. Baltimore, Williams & Wilkins Co, 1976, p 1.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jan 1, 1981

References