WIDI - CB1194-MR susceptibility (SWI)

MR susceptibility (SWI)

Claim CME Credit

0.5 CME Credit available on completion

POINT OF CARE INFORMATION

This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.

Learning Objectives

As a result of participation in this activity, participants should be able to:

Provide improved patient care.
Greater knowledge of the imaging characteristics of the patient's disease.
Understand a better approach to interpretation of studies.

Faculty Disclosure

Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.

CME Advisory Committee Disclosure:

Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.

Continuing Medical Education Credit

Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CB1194-MR susceptibility (SWI)

History

11 month old male with recent gastroenteritis treated with multiple antibiotics. Fever persisted along with adenoviral lymphadenitis, increasing irritability and depressed level of consciousness. An initial head MR was obtained. Over one month developed status epilepticus & HLH (hemophagocytic lymphohistiocytosis); a second MR was obtained 3 weeks later.

Exam

MR susceptibility (SWI)

Prior Study

MR flair
1. There are minimal changes of leptomeningeal reaction or leptomeningeal infection (possibly viral). The patient has been treated with antibiotics making CSF cultures negative. Differential includes immune overshoot response to the documented GI adenoviral infections (cytokine storm/SIRS) versus actual infectious leptomeningitis.

MR T1-w post contrast
1. Negative post contrast T1-w head MR coronal

MR diffusion
1. Regional, mainly parietal and ventral upper brain stem subpial edema and sulcal protein leak without contrast leak consistent with a humeral immune response. But, whether this represent partially treated leptomeningitis or a abnormal systemic immune response remains indeterminate.
2. Three small subcortical sites of positive MR diffusion are present consistent with cytogenic injury; basis is indeterminate.

Findings

MR susceptibility (SWI)

The MR susceptibility is negative of microhemorrhage. There may be minimal brain hyperemia, but these findings could fall within normal limits.

There is no "blooming SWI artifact" within any of the deep or superficial cortical veins to confirm actual venous thrombosis. Therefore, the observed edema and enhancement is paravenous rather than intravenous in location.