Leptomeningeal contrast enhancement and blood-CSF barrier dysfunction in aseptic meningitis

Angelika Alonso; Philipp Eisele; Anne D Ebert; Martin Griebe; Britta Engelhardt; Kristina Szabo; Michael G Hennerici; Achim Gass

doi:10.1212/NXI.0000000000000164

Leptomeningeal contrast enhancement and blood-CSF barrier dysfunction in aseptic meningitis

Neurol Neuroimmunol Neuroinflamm. 2015 Oct 15;2(6):e164. doi: 10.1212/NXI.0000000000000164. eCollection 2015 Dec.

Authors

Angelika Alonso¹, Philipp Eisele¹, Anne D Ebert¹, Martin Griebe¹, Britta Engelhardt¹, Kristina Szabo¹, Michael G Hennerici¹, Achim Gass¹

Affiliation

¹ Department of Neurology (A.A., P.E., A.D.E., M.G., K.S., M.G.H., A.G.), Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany; and Theodor Kocher Institute (B.E.), University of Bern, Bern, Switzerland.

Abstract

Objective: To investigate the blood-CSF barrier (BCSFB) dysfunction in aseptic meningitis.

Methods: In our case series of 14 patients with acute aseptic meningitis, we compared MRI characteristics with CSF findings.

Results: Contrast enhancement in the sulcal space in a leptomeningeal pattern was visualized in 7 patients with BCSFB dysfunction categorized as moderate to severe as evidenced by the CSF/serum albumin ratio (Qalb) but was not present in those with mild or no barrier disturbance (p = 0.001). The Qalb as a marker for the leakiness of the BCSFB and, more indirectly, of the blood-brain barrier (BBB) was positively correlated with the incidence of leptomeningeal contrast enhancement seen on postcontrast fluid-attenuated inversion recovery (FLAIR) MRI (p = 0.003). Patients with a more pronounced brain barrier dysfunction recovered more slowly and stayed longer in the hospital.

Conclusions: The severity of meningeal BBB disturbance can be estimated on postcontrast FLAIR MRI, which may be of diagnostic value in patients with aseptic meningitis.