A Simplified Approach to Encephalitis and Its Mimics: Key Clinical Decision Points in the Setting of Specific Imaging Abnormalities.

Autor:	McKnight CD; Department of Radiology, University of Michigan Medical Center, 1500 E. Medical Center Drive, UH B2-A209, Ann Arbor, MI 48109. Electronic address: colin.mcknight1@gmail.com., Kelly AM; Department of Radiology, University of Michigan Medical Center, 1500 E. Medical Center Drive, UH B2-A209, Ann Arbor, MI 48109., Petrou M; Department of Radiology, University of Michigan Medical Center, 1500 E. Medical Center Drive, UH B2-A209, Ann Arbor, MI 48109., Nidecker AE; Department of Radiology, University of California Davis Medical Center, Sacramento, California., Lorincz MT; Department of Neurology, University of Michigan, Ann Arbor, Michigan., Altaee DK; Department of Radiology, University of Michigan Medical Center, 1500 E. Medical Center Drive, UH B2-A209, Ann Arbor, MI 48109., Gebarski SS; Department of Radiology, University of Michigan Medical Center, 1500 E. Medical Center Drive, UH B2-A209, Ann Arbor, MI 48109., Foerster B; Department of Radiology, University of Michigan Medical Center, 1500 E. Medical Center Drive, UH B2-A209, Ann Arbor, MI 48109.
Jazyk:	angličtina
Zdroj:	Academic radiology [Acad Radiol] 2017 Jun; Vol. 24 (6), pp. 667-676. Date of Electronic Publication: 2017 Mar 01.
DOI:	10.1016/j.acra.2016.04.013
Abstrakt:	Rationale and Objectives: Infectious encephalitis is a relatively common cause of morbidity and mortality. Treatment of infectious encephalitis with antiviral medication can be highly effective when administered promptly. Clinical mimics of encephalitis arise from a broad range of pathologic processes, including toxic, metabolic, neoplastic, autoimmune, and cardiovascular etiologies. These mimics need to be rapidly differentiated from infectious encephalitis to appropriately manage the correct etiology; however, the many overlapping signs of these various entities present a challenge to accurate diagnosis. A systematic approach that considers both the clinical manifestations and the imaging findings of infectious encephalitis and its mimics can contribute to more accurate and timely diagnosis. Materials and Methods: Following an institutional review board approval, a health insurance portability and accountability act (HIPAA)-compliant search of our institutional imaging database (teaching files) was conducted to generate a list of adult and pediatric patients who presented between January 1, 1995 and October 10, 2013 for imaging to evaluate possible cases of encephalitis. Pertinent medical records, including clinical notes as well as surgical and pathology reports, were reviewed and correlated with imaging findings. Clinical and imaging findings were combined to generate useful flowcharts designed to assist in distinguishing infectious encephalitis from its mimics. Key imaging features were reviewed and were placed in the context of the provided flowcharts. Results: Four flowcharts were presented based on the primary anatomic site of imaging abnormality: group 1: temporal lobe; group 2: cerebral cortex; group 3: deep gray matter; and group 4: white matter. An approach that combines features on clinical presentation was then detailed. Imaging examples were used to demonstrate similarities and key differences. Conclusions: Early recognition of infectious encephalitis is critical, but can be quite complex due to diverse pathologies and overlapping features. Synthesis of both the clinical and imaging features of infectious encephalitis and its mimics is critical to a timely and accurate diagnosis. The use of the flowcharts presented in this article can further enable both clinicians and radiologists to more confidently differentiate encephalitis from its mimics and improve patient care. (Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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