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Background: Viral meningitis/encephalitis (ME) is a rare but potentially harmful disease. The prompt identification of the respective virus is important to guide not only treatment but also potential public health countermeasures. However, in about 40% of cases, no virus is identified despite an extensive diagnostic workup. The aim of the present study was to analyze demographic, seasonal, and routine cerebrospinal fluid (CSF) parameters in cases of viral ME and assess their utility for the prediction of the causative virus. Methods: Demographic data, season, and routine CSF parameters (total leucocytes, CSF cell differentiation, age-adjusted CSF/serum albumin ratio, and total immunoglobulin ratios) were retrospectively assessed in cases of viral ME. Results: In total, 156 cases of acute viral ME (74 female, median age 40.0 years) were treated at a tertiary-care hospital in Germany. Specific viral infections were detected in 93 (59.6%) cases. Of these, 14 (9.0%) cases were caused by herpes simplex virus (HSV), 36 (23.1%) by varicella-zoster virus (VZV), 27 (17.3%) by enteroviruses, 9 (5.8%) by West Nile virus (WNV), and 7 (4.5%) by other specific viruses. Additionally, 64 (41.0%) cases of ME of unknown viral etiology were diagnosed. Cases of WNV ME were older, predominantly male, showed a severe disruption of the blood–CSF–barrier, a high proportion of neutrophils in CSF, and an intrathecal total immunoglobulin M synthesis in the first CSF sample. In a multinominal logistic regression analysis, the accuracy of these CSF parameters together with age and seasonality was best for the prediction of WNV (87.5%), followed by unknown viral etiology (66.7%), VZV (61.8%), and enteroviruses (51.9%). Conclusions: Cases with WNV ME showed a specific pattern of routine CSF parameters and demographic data that allowed for their identification with good accuracy. These findings might help to guide the diagnostic workup in cases with viral ME, in particular allowing the timely identification of cases with ME due to WNV. [ABSTRACT FROM AUTHOR]

Background and Purpose: Extracranial internal carotid artery stenoses (ICASs) may greatly differ with respect to morphological and hemodynamical aspects. The aim of this pilot study was to evaluate the use of multiparametric 3-dimensional (3D) contrast-enhanced ultrasound (3D-CEUS) to comprehensively examine ICAS.Methods: Fifteen patients with moderate to severe ICAS were examined with multiparametric 3D-CEUS, power-mode 3D ultrasound (3DUS), color-coded duplex sonography (CDS), and digital subtraction angiography (DSA) (n = 9). Multiparametric 3D-CEUS comprised the assessment of the morphology and the stenotic degree of ICAS and the measurement of the ipsistenotic cerebral circulation time (CCT).Results: Multiparametric 3D-CEUS reliably visualized even complex aspects of ICAS such as ulcerated or heavily calcified plaques with high spatial resolution. When comparing the different methods to quantify ICAS, the intermethod agreement was good (ranging from poor to excellent) between 3D-CEUS and CDS, moderate (ranging from poor to good) between 3D-CEUS and DSA, and poor (ranging from poor to good) between CDS and DSA. The CCT was significantly longer in patients with ICAS than in healthy subjects (8.2 ± 1.5 seconds vs. 6.5 ± 1.3 seconds, P = .026).Conclusion: In this pilot study, bedside multiparametric 3D-CEUS provided reliable estimations of different morphological and hemodynamical aspects of ICAS, thus ideally complementing CDS. [ABSTRACT FROM AUTHOR]

Introduction: Reported sonographic reference values for the vagus nerves (VNs) vary greatly. We aimed to generate reference values in a large cohort and examine intrarater, interrater, and across-ultrasound systems agreement.Methods: The VNs of 60 healthy subjects were examined by 2 sonographers and with 2 ultrasound systems. Cross-sectional areas (CSAs) of each VN were assessed at the level of the carotid sinus [proximal measurement level (ML)] and thyroid gland (distal ML).Results: Mean VN CSA was significantly larger on the right side (proximal ML: 2.7 ± 0.6 mm2 vs. 2.1 ± 0.5 mm2 ; distal ML: 2.6 ± 0.6 mm2 vs. 1.9 ± 0.4 mm2 ). VN CSA decreased with increasing age. There were good intrarater, interrater, and across-ultrasound systems agreements.Discussion: The right VN CSA is significantly larger than the left. These side- and age-specific reference values for the VN may be useful for future studies. Muscle Nerve 57: 766-771, 2018. [ABSTRACT FROM AUTHOR]