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We present the initial MR and PET work-up in a diabetic 31-year-old female patient presenting with spinal cord compression because of abnormal meningeal tissue and highlight the close correlation between the clinical course and the monitoring of the lesions on MR images. The combination of non-specific inflammatory signs at histopathological examination and of the negative results of a comprehensive bacteriological and serological testing led to the diagnosis of idiopathic hypertrophic spinal pachymeningitidis. The abnormal tissue showed mild glucose uptake at whole-body FDG-PET examination. Repeated MR follow-up examinations during corticoid treatment only demonstrated partial shrinkage of the abnormal tissue. Symptomatic relapse and re-increase in lesion size on MR images occurred concomitantly after an 11-month symptom-free remitting interval under tapering corticoid treatment.

Serratia marcescens is an unusual cause of community-acquired meningitis in adults. We report a case of S. marcescens meningitis occurring 29 years after a head injury and preceded by 3 years of intermittent nasal discharge of cerebrospinal fluid (CSF). One month before admission, the patient had received treatment with cefadroxil. This case illustrates the risk of Gram-negative bacillary meningitis in patients with a CSF leak when they are treated with antibiotics. When patients have a chronic clear nasal discharge, one should look for a past medical history of head injury before prescribing antibiotics. In the presence of a fistula, any antibiotherapy may lead to the selection of resistant organisms which may be difficult to treat. Due to the high risk of meningitis and the fact that spontaneous closure in delayed CSF rhinorrhoea is unlikely, surgical repair of any associated fistulae is mandatory.

We report four patients with Behçet's disease characterized by initial and predominant neurological signs and symptoms. In three cases, a clinical picture of relapsing meningoencephalitis preceded the appearance of the classical signs of the disease for several months or years; in the fourth case, an acute febrile aseptic meningitis coincided with the development of bipolar aphthosis and uveitis. Disease activity was linked to a blood inflammatory syndrome and neutrophilic leucocytosis. Acute phases were associated with CSF mixed pleocytosis and high protein content. Brain CT scans and MRI were very effective to detect lesions which are mainly located in the brain stem and basal ganglia. High-dose corticosteroids and, in cases of relapses, immunosuppressive drugs were required to treat these severe forms of Behçet's disease.

The level of C-reactive protein (CRP) was determined in the cerebrospinal fluid (CSF) by particle counting immunoassay. In non-neurological patients (N = 24), CRP was detectable only in 10 samples at concentrations ranging from 1.5 to 37 micrograms/l. The multiple sclerosis group did not differ from the controls. The highest CRP levels were found in viral and bacterial, including tuberculous, infections of the nervous system, with overlapping results for the various types of infections. However, in serum, the levels of CRP were much higher in pyogenic than in viral meningitis. We compared the CSF CRP/serum CRP ratio to the same ratio for albumin and found a significant correlation between the two ratios in viral, but not in bacterial, infections. These results suggest a local consumption of CRP during bacterial meningitis.

Otitis media in a 43 year-old male patient was followed by signs of chronic meningitis with persistent headaches, moderate pleiomorphic lymphocytosis of CSF without hypoglycorrhachia and unilateral impairment of cranial nerves XI to II. These signs were accompanied by widespread inflammation with general deterioration of the patient's condition. After a time the tentorium of cerebellum showed thickening and significant contrast uptake in conjunction with necrotizing granulomatous inflammation, indicating tentorial pachymeningitis. Swift and complete remission was obtained with a corticoid-cyclophosphamide combination. After reviewing the other possible causes of chronic meningitis, the authors proposed a diagnosis of Wegener's disease of auricular origin in view of the compatibility of all the data. A few cases of cranial pachymeningitis of indeterminate origin are described in the literature. Only this patient was treated with a corticoid-cyclophosphamide combination. The remarkable efficacy of this double therapy confirms the diagnostic hypothesis of Wegener's granulomatosis.

Clinical features of 18 patients with either lymphocytic meningoradiculitis (n = 17) or chronic encephalomyelitis (n = 1) due to Borrelia burgdorferi are reported. Arthropod bites were recorded in only seven patients. High titres of anti B burgdorferi antibodies were detected in sera from all patients and in CSF from 12 out of 17 patients tested. All patients had CSF abnormalities especially pleocytosis and oligoclonal bands. A falsely positive syphilitic serology was observed in the CSF from the patient with encephalomyelitis.

We assayed immune complexes (IC) by Particle Counting ImmunoAssay in the serum and cerebrospinal fluid (CSF) of patients with various neurological disorders. In pyogenic meningitis, the levels of IC sharply increased 4-8 days after onset with a fall before the 10th day of the disease. In herpetic encephalitis the IC and antibody levels started to increase about 12 days after onset. The IC persisted at high values for 3-4 weeks, whereas the high antibody titers persisted for several months during the follow-up. In these 2 groups of patients IC were probably locally produced as indicated by the lack of correlation with the IC levels in the serum. We did not detect any significant increase of IC in the serum and CSF of patients with multiple sclerosis (N = 48) or with acute idiopathic polyradiculoneuritis (N = 11). Using another technique based on the determination of IgG and C4 in polyethylene glycol precipitates we also failed to detect any significant increase of IC in multiple sclerosis sera.

A 30-year-old, previously healthy, non-addicted man presented with a chronic spinal meningitis complicated by arachnoiditis and spinal cord compression. Biopsy showed a chronic granulomatous leptomeningitis, in which some cells contained branching septate organisms that were immunostained with an antiserum to Aspergillus fumigatus. Precipitins to A. fumigatus were detected in cerebrospinal fluid (CSF), but not in blood, and aspergillus infection was apparently restricted to the leptomeninges. Clinically successful treatment led to the disappearance of CSF precipitins and oligoclonal bands.

The MR monitoring of a patient with acute spontaneous intracranial hypotension successfully treated by epidural blood patch revealed strikingly different time course of the initially concomitant cranial and spinal subdural fluid collections. This undescribed feature suggested different pathophysiological mechanisms for the disorder in the two locations and should be kept in mind when imaging patients with the condition. [ABSTRACT FROM AUTHOR]

A 30-year-old, previously healthy, non-addicted man presented with a chronic spinal meningitis complicated by arachnoiditis and spinal cord compression. Biopsy showed a chronic granulomatous leptomeningitis, in which some cells contained branching septate organisms that were immunostained with an antiserum to Aspergillus fumigatus. Precipitins to A. fumigatus were detected in cerebrospinal fluid (CSF), but not in blood, and aspergillus infection was apparently restricted to the leptomeninges. Clinically successful treatment led to the disappearance of CSF precipitins and oligoclonal bands. [ABSTRACT FROM AUTHOR]