Journal of neuroimaging : official journal of the American Society of Neuroimaging
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Case Reports
Concurrent West Nile virus infection in pneumococcal meningitis: clinical and MRI features.
We report the clinical and neuroimaging findings of an immunocompetent patient with concurrent pneumococcal and West Nile virus meningoencephalitis with relapsing clinical course despite a full course of antibiotic treatment. The patient developed acute oculomotor nerve palsy with pupillary involvement and bilateral hearing loss, and delayed right leg monoparesis. We speculate that coexisting bacterial and viral neuroinvasive infections contributed to the unusual clinical and imaging manifestations, and that overwhelming laboratory and clinical features of bacterial meningitis masked the typical features of CNS viral infection. Therefore, atypical presentations of bacterial meningitis should raise a high index of suspicion for coexisting infections, even in immunocompetent patients, and evolving neuroimaging findings may be helpful in substantiating clinical suspicion and guiding further management.
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Diffusion tensor imaging (DTI) is useful for multiple clinical applications, but its routine implementation for children may be difficult due to long scan times. This study evaluates the impact of decreasing the number of DTI acquisitions (NEX) on interpretability of pediatric brain DTI. ⋯ Reducing NEX to shorten imaging time may impact clinical utility in a manner that does not directly correspond with SNR changes.