Psychiatric symptoms due to infectious and autoimmune-mediated central nervous system disorders: can brain MRI help to solve the riddle?
Abstract
A wide spectrum of organic diseases, including endocrine, metabolic and neurological disorders, may be the underlying cause of secondary psychiatric disorders. The diagnostic algorithm of a patient presenting with newly manifested psychiatric symptoms in the emergency department, entails exclusion of possible organic disease as underlying cause of psychiatric symptomatology and relies on neurological evaluation, cerebrospinal fluid analyses and brain imaging. Brain magnetic resonance imaging is an indispensable diagnostic modality for the differentiation between primary and secondary psychiatric disorders. In this article, we focus on the differential diagnosis and MRI findings of infectious and immune-mediated central nervous system disorders in patients presenting with newly manifested psychiatric symptoms. We emphasise that accurate and prompt diagnosis of secondary psychiatric disorders is crucial in order to optimise treatment and improve clinical prognosis.
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Talbot-Stern JK, Green T, Royle TJ. Psychiatric manifestations of systemic illness. Emerg Med Clin North Am 2000; 18(2): 199-209.
Testa A, Giannuzzi R, Daini S, et al. Psychiatric emergencies (part III): psychiatric symptoms resulting from organic diseases. Eur Rev Med Pharmacol Sci 2013; 17(Suppl 1): 86-99.
Dorsett M, Liang SY. Diagnosis and treatment of central nervous system infections in the emergency department. Emerg Med Clin 2016; 34(4): 917-942.
Waghdhare S, Kalantri A, Joshi R, et al. Accuracy of physical signs for detecting meningitis: a hospital-based diagnostic accuracy study. Clin Neurol Neurosurg 2010; 112(9): 752-757.
Goeb JL, Leon V, Kechid G. Cryptococcal meningitis with acute psychotic confusion in a sarcoid patient. Prim Care Companion J Clin Psychiatry 2007; 9(5): 393-394.
Hughes DC, Raghavan A, Mordekar SR, et al. Role of imaging in the diagnosis of acute bacterial meningitis and its complications. Postgrad Med J 2010; 86(1018): 478-485.
Smirnitopoulos JG, Murphy FM, Rushing EJ, et al. Patterns of contrast enhancement in the brain and meninges. Radiographics 2007; 27(2): 525-551.
Rohde S. Inflammatory diseases of the meninges. In: Inflammatory Diseases of the Brain. Springer, Berlin, Heidelberg 2009, pp 169-183.
Fukuoka H, Hirai T, Okuda T, et al. Comparison of the added value of contrast-enhanced 3D fluid-attenuated inversion recovery and magnetization-prepared rapid acquisition of gradient echo sequences in relation to conventional postcontrast T1-weighted images for the evaluation of leptomeningeal diseases at 3T. AJNR Am J Neuroradiol 2010; 31(5): 868-873.
Zhang Y, Xiao X, Zhang J, et al. Diagnostic accuracy of routine blood examinations and CSF lactate level for post-neurosurgical bacterial meningitis. Int J Infect Dis 2017; 59: 50-54.
Geanerod J, Davies NWS, Mukonoweshuro W, et al. Neuroimaging in encephalitis: analysis of imaging findings and interobserver agreement. Clin Radiol 2016; 71(10): 1050-1058.
Venkatesan A, Geocadin RG. Diagnosis and management of acute encephalitis: A practical approach. Neurol Clin Pract 2014; 4(3): 206-215.
Bertrand A, Laclercq D, Martinez-Almoyna L, et al. MR imaging of adult acute infectious encephalitis. Med Mal Infect 2017; 47(3): 195-205.
Rath TJ, Hughes M, Arabi M, et al. Imaging of cerebritis, encephalitis, and brain abscess. Neuroimaging Clin N Am 2012; 22(4): 585-607.
Solomon T, Michael BD, Smith PE, et al. Management of suspected viral encephalitis in adults-association of British Neurologists and British Infection Association National Guidelines. J Infect 2012; 64(4): 347-373.
Jayaraman K, Rangasami R, Chandrasekharan A, et al. Magnetic resonance imaging findings in viral encephalitis: A pictorial essay. J Neurosci Rural Pract 2018; 9(4): 556-560.
Venkatesan A, Jagdish B. Imaging in Encephalitis. Semin Neurol 2019; 39(03): 312-321.
Muccio CF, Caranci F, D’Arco F, et al. Magnetic resonance features of pyogenic brain abscesses and differential diagnosis using morphological and functional imaging studies: a pictorial essay. J Neuroradiol 2014; 41(3): 153-167.
Lai PH, Chang HC, Chuan T, et al. Susceptibility-weighted imaging in patients with pyogenic brain abscesses at 1.5 T: characteristics of the abscess capsule. AJNR Am J Neuroradiol 2012; 33(5): 910-914.
Toh CH, Wei KC, Chang CN, et al. Differentiation of pyogenic brain abscesses from necrotic glioblastomas with use of susceptibility-weighted imaging. AJNR Am J Neuroradiol 2012; 33(8): 1534-1538.
Lai PH, Li KT, Hsu SS, et al. Pyogenic brain abscess: findings from in vivo 1.5-T and 11.7-T in vitro proton MR spectroscopy. AJNR Am J Neuroradiol 2005; 26(2): 279-288.
Pal D, Bhattacharyya A, Husain M, et al. In vivo proton MR spectroscopy evaluation of pyogenic brain abscesses: a report of 194 cases. AJNR Am J Neuroradiol 2010; 31(2): 360-366.
Toh CH, Wei KC, Chang CN, et al. Differentiation of brain abscesses from glioblastomas and metastatic brain tumors: comparisons of diagnostic performance of dynamic susceptibility contrast-enhanced perfusion MR imaging before and after mathematic contrast leakage correction. PLoS One 2014; 9(10): e109172.
Chiang IC, Hsieh TJ, Chiu ML, et al. Distinction between pyogenic brain abscess and necrotic brain tumour using 3-tesla MR spectroscopy, diffusion and perfusion imaging. Br J Radiol 2009; 82(982): 813-820.
Castro I, Ruiz J, Tasias M, et al. Central nervous system infections in immunocompromised patients. Revista Española de Quimioterapia 2018; 31(Suppl 1): 56.
Dibble EH, Boxerman JL, Baird GL, et al. Toxoplasmosis versus lymphoma: Cerebral lesion characterization using DSC-MRI revisited. Clin Neurol Neurosur 2017; 152: 84-89.
Vidal JE. HIV-related cerebral toxoplasmosis revisited: current concepts and controversies of an old disease. J Int Assoc Provid AIDS Care 2019; 18: 2325958219867315.
Kumar GGS, Mahadevan A, Guruprasad AS, et al. Eccentric target sign in cerebral toxoplasmosis: neuropathological correlate to the imaging feature. J Magn Reson Imaging 2010; 31(6): 1469-1472.
Mahadevan A, Ramalingaiah AH, Parthasarathy S, et al. Neuropathological correlate of the “concentric target sign” in MRI of HIV-associated cerebral toxoplasmosis. J Magn Reson Imaging 2013; 38(2): 488-495.
Góralska K, Blaszkowska J, Dzikowiec M, et al. Neuroinfections caused by fungi. Infection 2018; 46(4): 443-459.
Gavito-Higuera J, Mullins CB, Ramos-Duran L, et al. Fungal infections of the central nervous system: a pictorial review. J Clin Imaging Sci 2016; 6: 24.
Schwartz S, Kontoyiannis DP, Harrison T, et al. Advances in the diagnosis and treatment of fungal infections of the CNS. Lancet Neurol 2018; 17(4): 362-372.
Honce JM, Nagae L, Nyberg E. Neuroimaging of natalizumab complications in multiple sclerosis: PML and other associated entities. Mult Scler Int 2015; 2015: 809252.
Anand P, Hotan GC, Vogel A, et al. Progressive multifocal leukoencephalopathy: A 25-year retrospective cohort study. Neurol Neuroimmunol Neuroinflamm 2019; 6(6): e618.
Ma H, Liu Y, Zhuang C, et al. Clinical features and MRI findings of intracranial tuberculomas. Radiol Infect Dis 2018; 5(4): 154-159.
Khatri GD, Krishnan V, Antil N, et al. Magnetic resonance imaging spectrum of intracranial tubercular lesions: one disease, many faces. Pol J Radiol 2018; 83: 524-e535.
Dubey D, Alqallaf A, Hays R, et al. Neurological autoantibody prevalence in epilepsy of unknown etiology. JAMA Neurol 2017; 74(4): 397-402.
Torrico T, Abdijadid S. Neuroanatomy, Limbic System. In: StatPearls [Internet]. StatPearls Publishing, 2019. Updated July 31, 2020. Accessed July 15, 2020.
Hermetter C, Fazekas F, Hochmeister S. Systematic review: syndromes, early diagnosis, and treatment in autoimmune encephalitis. Front Neurol 2018; 9: 706.
Tuzun E, Dalmau J. Limbic encephalitis and variants: classification, diagnosis and treatment. Neurologist 2007; 13(5): 261-271.
Newman MP, Blum S, Wong RCW, et al. Autoimmune encephalitis. Intern Med J 2016; 46(2): 148-157.
Ryan SA, Costello DJ, Cassidy EM, et al. Anti-NMDA receptor encephalitis: a cause of acute psychosis and catatonia. J Psychiatr Pract 2013; 19(2): 157-161.
Dubey D, Blackburn K, Greenberg B, et al. Diagnostic and therapeutic strategies for management of autoimmune encephalopathies. Expert Rev Neurother 2016; 16(8): 937-949.
Tardive dyskinesia: a task force report of the American Psychiatric Association. American Psychiatric Association, Washington DC 1992, pp 1163-1172.
HöftbergerR, Lassmann H. Immune-mediated disorders. In: Handbook of Clinical Neurology. Elsevier, 2018, pp 285-299.
Ances BM, Vitaliani R, Taylor RA, et al. Treatment-responsive limbic encephalitis identified by neuropil antibodies: MRI and PET correlates. Brain 2005; 128(8): 1764-1777.
Urbach H, Soeder BM, Jeub M, et al. Serial MRI of limbic encephalitis. Neuroradiology 2006; 48(6): 380-386.
Graus F, Delattre JY, Antoine JC, et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol 2016; 15(4): 391-404.
Sener RN. MRI and diffusion MRI in nonparaneoplastic limbic encephalitis. Comput Med Imaging Graph 2002; 26(5): 339-342.
Kelley BP, Patel SC, Marin HL, et al. Autoimmune encephalitis: pathophysiology and imaging review of an overlooked diagnosis. AJNR Am J Neuroradiol 2017; 38(6): 1070-1078.
Lancaster E. The diagnosis and treatment of autoimmune encephalitis. J Clin Neurol 2016; 12(1): 1-13.
Solnes LB, Jones KM, Rowe S, et al. Diagnostic value of 18F-FDG PET/CT versus MRI in the setting of antibody-specific autoimmune encephalitis. J Nucl Med 2017; 58(8): 1307-1313.
DOI: http://dx.doi.org/10.36162/hjr.v5i3.403
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