Durale und leptomeningeale Erkrankungen: Anatomie, Ursachen und Neurobildgebung

Meningeale Läsionen können durch verschiedene Erkrankungen verursacht werden und stellen eine diagnostische Herausforderung dar. Die Autoren untersuchen die Anatomie der Meningen im Gehirn und Rückenmark, um die Lokalisierung und Ausdehnung dieser Erkrankungen besser zu verstehen, und fassen die klinischen und bildgebenden Merkmale verschiedener Erkrankungen zusammen, die zu duralen und/oder leptomeningealen Läsionen führen.

Kernaussagen

• Es gibt 2 verschiedene Anreicherungsmuster der Meningen: das Dura-Arachnoidea-Muster (linear pachymeningeal) und das Pia-Subarachnoidea-Muster (leptomeningeal).

• Bei Neugeborenen und Säuglingen ist eine Meningitis durch Infektion mit Streptokokken der Gruppe B im Vergleich zu einer bakteriellen Meningitis durch andere Erreger häufiger mit der Diagnose eines Hirninfarkts assoziiert (59% der Fälle), oft mit multifokaler oder ausgedehnter Verteilung über mehrere Gefäßterritorien.

• Eine Beteiligung des Ohres (Mittelohrentzündung), der Augenhöhle (z.B. Beteiligung der Tränendrüse, okuläres Granulom oder ischämische Optikusneuropathie) und der Nase (Sinusitis) sind diagnostische Indikatoren für eine ANCA-assoziierte Vaskulitis.

• Metastasen breiten sich über verschiedene Wege aus, z.B. über den Batson-Plexus, perineurale Lymphgefäße, den Subarachnoidalraum (d.h. als sogenannte Abtropfmetastasen), das arterielle System und die Invasion aus angrenzenden Strukturen.

• Verschiedene Erscheinungsbilder von Neuropathien werden mit Immuncheckpoint-Inhibitoren in Verbindung gebracht, darunter kraniale Neuropathie (37%), Polyradikuloneuropathie (32%) sowie Small-Fiber- und autonome Neuropathie (11%) mit oder ohne aseptische Meningitis.

Schlüsselwörter

Meningen - Bildgebung - Meningitis - Autoimmunerkrankungen - Tumoren

Publikationsverlauf

Artikel online veröffentlicht:
08. April 2025

• Literatur

• 1 Wiley AM, Trueta J. The vascular anatomy of the spine and its relationship to pyogenic vertebral osteomyelitis. J Bone Joint Surg Br 1959; 41: 796-809
• 2 Yáñez ML, Miller JJ, Batchelor TT. Diagnosis and treatment of epidural metastases. Cancer 2017; 123: 1106-1114
• 3 Hoffman O, Weber RJ. Pathophysiology and treatment of bacterial meningitis. Ther Adv Neurol Disord 2009; 2: 1-7
• 4 Kamagata K, Andica C, Takabayashi K. et al. for the Alzheimer’s Disease Neuroimaging Initiative Association of MRI indices of glymphatic system with amyloid deposition and cognition in mild cognitive impairment and Alzheimer disease. Neurology 2022; 99: e2648-e2660
• 5 Chen F, Xie X, Wang L. Research progress on intracranial lymphatic circulation and its involvement in disorders. Front Neurol 2022; 13: 865714
• 6 Møllgård K, Beinlich FRM, Kusk P. et al. A mesothelium divides the subarachnoid space into functional compartments. Science 2023; 379: 84-88
• 7 Mastorakos P, McGavern D. The anatomy and immunology of vasculature in the central nervous system. Sci Immunol 2019; 4: eaav0492
• 8 Sakka L. Anatomy of the cranial and spinal meninges. In: Cinalli G, Özek M, Sainte-Rose C. , Hrsg. Pediatric Hydrocephalus. Cham, Switzerland: Springer; 2018: 1-55
• 9 Weller RO. Microscopic morphology and histology of the human meninges. Morphologie 2005; 89: 22-34
• 10 Nagel SJ, Reddy CG, Frizon LA. et al. Spinal dura mater: biophysical characteristics relevant to medical device development. J Med Eng Technol 2018; 42: 128-139
• 11 Mortazavi MM, Quadri SA, Khan MA. et al. Subarachnoid trabeculae: a comprehensive review of their embryology, histology, morphology, and surgical significance. World Neurosurg 2018; 111: 279-290
• 12 Meltzer CC, Fukui MB, Kanal E. et al. MR imaging of the meninges. Part I. Normal anatomic features and nonneoplastic disease. Radiology 1996; 201: 297-308
• 13 Smirniotopoulos JG, Murphy FM, Rushing EJ. et al. Patterns of contrast enhancement in the brain and meninges. RadioGraphics 2007; 27: 525-551
• 14 Vaswani AK, Nizamani WM, Ali M. et al. Diagnostic accuracy of contrast-enhanced FLAIR magnetic resonance imaging in diagnosis of meningitis correlated with CSF analysis. ISRN Radiol 2014; 2014: 578986
• 15 Roos KL, vande Beek D. Bacterial meningitis. Handb Clin Neurol 2010; 96: 51-63
• 16 Romain AS, Cohen R, Plainvert C. et al. Clinical and laboratory features of group B Streptococcus meningitis in infants and newborns: study of 848 cases in France, 2001–2014. Clin Infect Dis 2018; 66: 857-864
• 17 Jaremko JL, Moon AS, Kumbla S. Patterns of complications of neonatal and infant meningitis on MRI by organism: a 10 year review. Eur J Radiol 2011; 80: 821-827
• 18 Mook-Kanamori BB, Geldhoff M, van der Poll T. et al. Pathogenesis and pathophysiology of pneumococcal meningitis. Clin Microbiol Rev 2011; 24: 557-591
• 19 Sanei Taheri M, Karimi MA, Haghighatkhah H. et al. Central nervous system tuberculosis: an imaging-focused review of a reemerging disease. Radiol Res Pract 2015; 2015: 202806
• 20 Singh BS, Patwari AK, Deb M. Serum sodium and osmolal changes in tuberculous meningitis. Indian Pediatr 1994; 31: 1345-1350
• 21 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: e524-e535
• 22 Wright WF, Pinto CN, Palisoc K. et al. Viral (aseptic) meningitis: a review. J Neurol Sci 2019; 398: 176-183
• 23 Jaques DA, Bagetakou S, L’Huillier AG. et al. Herpes simplex encephalitis as a complication of neurosurgical procedures: report of 3 cases and review of the literature. Virol J 2016; 13: 83
• 24 Liu Q, Zhou X, Li Z. Acute myelitis with multicranial neuritis caused by Varicella zoster virus: a case report. BMC Neurol 2022; 22: 45
• 25 You IC, Ahn M, Cho NC. A case report of herpes zoster ophthalmicus and meningitis after COVID-19 vaccination. J Korean Med Sci 2022; 37: e165
• 26 Medhat R, El Lababidi R, Abdelsalam M. et al. Varicella-zoster virus (VZV) meningitis in an immunocompetent adult after BNT162b2 mRNA COVID-19 vaccination: a case report. Int J Infect Dis 2022; 119: 184-186
• 27 Buranasakda M, Kotruchin P, Phanthachai K. et al. Varicella zoster meningitis following COVID-19 vaccination: a report of two cases. Int J Infect Dis 2022; 119: 214-216
• 28 Maruki T, Ishikane M, Suzuki T. et al. A case of varicella zoster virus meningitis following BNT162b2 mRNA COVID-19 vaccination in an immunocompetent patient. Int J Infect Dis 2021; 113: 55-57
• 29 Abbas SA, El Helou J, Chalah MA. et al. Longitudinal extensive transverse myelitis in an immunocompetent older individual – a rare complication of varicella-zoster virus reactivation. Medicina (Kaunas) 2019; 55: 201
• 30 Duarte SBL, Oshima MM, Mesquita JVDA. et al. Magnetic resonance imaging findings in central nervous system cryptococcosis: comparison between immunocompetent and immunocompromised patients. Radiol Bras 2017; 50: 359-365
• 31 Kurokawa M, Kurokawa R, Baba A. et al. Deadly fungi: Invasive fungal rhinosinusitis in the head and neck. RadioGraphics 2022; 42: 2075-2094
• 32 Zhang S, Yuan D, Tan G. Neurological involvement in primary systemic vasculitis. Front Neurol 2019; 10: 430
• 33 Zheng Y, Zhang Y, Cai M. et al. Central nervous system involvement in ANCA-associated vasculitis: what neurologists need to know. Front Neurol 2019; 9: 1166
• 34 Guzman-Soto MI, Kimura Y, Romero-Sanchez G. et al. From head to toe: granulomatosis with polyangiitis. RadioGraphics 2021; 41: 1973-1991
• 35 Yokoseki A, Saji E, Arakawa M. et al. Hypertrophic pachymeningitis: significance of myeloperoxidase anti-neutrophil cytoplasmic antibody. Brain 2014; 137: 520-536
• 36 Higashida-Konishi M, Akiyama M, Shimada T. et al. Aseptic meningitis as an initial manifestation of primary Sjögren’s syndrome. Mod Rheumatol Case Rep 2022; 2022: rxac095
• 37 Villa E, Sarquis T, de Grazia J. et al. Rheumatoid meningitis: a systematic review and meta-analysis. Eur J Neurol 2021; 28: 3201-3210
• 38 Bhagavati S. Autoimmune disorders of the nervous system: pathophysiology, clinical features, and therapy. Front Neurol 2021; 12: 664664
• 39 Dalmau J, Armangué T, Planagumà J. et al. An update on anti-NMDA receptor encephalitis for neurologists and psychiatrists: mechanisms and models. Lancet Neurol 2019; 18: 1045-1057
• 40 Zhang T, Duan Y, Ye J. et al. Brain MRI characteristics of patients with anti-N-methyl-D-aspartate receptor encephalitis and their associations with 2-year clinical outcome. AJNR Am J Neuroradiol 2018; 39: 824-829
• 41 Saip S, Akman-Demir G, Siva A. Neuro-Behçet syndrome. Handb Clin Neurol 2014; 121: 1703-1723
• 42 Hisanaga K. Neuro-Behçet disease, neuro-Sweet disease, and spectrum disorders. Intern Med 2022; 61: 447-450
• 43 Theodorou A, Palaiodimou L, Safouris A. et al. Cerebral amyloid angiopathy-related inflammation: a single-center experience and a literature review. J Clin Med 2022; 11: 6731
• 44 Cogswell PM, Barakos JA, Barkhof F. et al. Amyloid-related imaging abnormalities with emerging Alzheimer disease therapeutics: detection and reporting recommendations for clinical practice. AJNR Am J Neuroradiol 2022; 43: E19-E35
• 45 Barakos J, Sperling R, Salloway S. et al. MR imaging features of amyloid-related imaging abnormalities. AJNR Am J Neuroradiol 2013; 34: 1958-1965
• 46 Marrodan M, Fiol MP, Correale J. Susac syndrome: challenges in the diagnosis and treatment. Brain 2022; 145: 858-871
• 47 Coulette S, Lecler A, Saragoussi E. et al. Diagnosis and prediction of relapses in Susac syndrome: a new use for MR postcontrast FLAIR leptomeningeal enhancement. AJNR Am J Neuroradiol 2019; 40: 1184-1190
• 48 Bradshaw MJ, Pawate S, Koth LL. et al. Neurosarcoidosis: pathophysiology, diagnosis, and treatment. Neurol Neuroimmunol Neuroinflamm 2021; 8: e1084
• 49 Walling AD, Dickson G. Guillain-Barré syndrome. Am Fam Physician 2013; 87: 191-197
• 50 Hughes RA, Hadden RD, Gregson NA. et al. Pathogenesis of Guillain-Barré syndrome. J Neuroimmunol 1999; 100: 74-97
• 51 Keh RYS, Scanlon S, Datta-Nemdharry P. et al. BPNS/ABN COVID-19 Vaccine GBS Study Group. COVID-19 vaccination and Guillain-Barré syndrome: analyses using the National Immunoglobulin Database. Brain 2023; 146: 739-748
• 52 Land CF, Bowden BD, Morpeth BG. et al. Intradural extramedullary metastasis: a review of literature and case report. Spinal Cord Ser Cases 2019; 5: 41
• 53 Louis DN, Perry A, Wesseling P. et al. The 2021 WHO Classification of Tumors of the Central Nervous System: a summary. Neuro Oncol 2021; 23: 1231-1251
• 54 Watts J, Box G, Galvin A. et al. Magnetic resonance imaging of meningiomas: a pictorial review. Insights Imaging 2014; 5: 113-122
• 55 Kunimatsu A, Kunimatsu N, Kamiya K. et al. Variants of meningiomas: a review of imaging findings and clinical features. Jpn J Radiol 2016; 34: 459-469
• 56 Métais A, Bouchoucha Y, Kergrohen T. et al. Pediatric spinal pilocytic astrocytomas form a distinct epigenetic subclass from pilocytic astrocytomas of other locations and diffuse leptomeningeal glioneuronal tumours. Acta Neuropathol (Berl. ) 2023; 145: 83-95
• 57 Porto L, Kieslich M, Bartels M. et al. Leptomeningeal metastases in pediatrics: magnetic resonance image manifestations and correlation with cerebral spinal fluid cytology. Pediatr Int 2010; 52: 541-546
• 58 Kurokawa R, Umemura Y, Capizzano A. et al. Dynamic susceptibility contrast and diffusion-weighted MRI in posterior fossa pilocytic astrocytoma and medulloblastoma. J Neuroimaging 2022; 32: 511-520
• 59 Kurokawa R, Kurokawa M, Baba A. et al. Major changes in 2021 World Health Organization Classification of Central Nervous System tumors. RadioGraphics 2022; 42: 1474-1493
• 60 Nayak L, Abrey LE, Iwamoto FM. Intracranial dural metastases. Cancer 2009; 115: 1947-1953
• 61 Batool A, Kasi A. Leptomeningeal carcinomatosis. Treasure Island, Fla: StatPearls; 2024
• 62 Fitsiori A, Fornecker LM, Simon L. et al. Imaging spectrum of Bing-Neel syndrome: How can a radiologist recognise this rare neurological complication of Waldenström’s macroglobulinemia?. Eur Radiol 2019; 29: 102-114
• 63 Kemps PG, Picarsic J, Durham BH. et al. ALK-positive histiocytosis: a new clinicopathologic spectrum highlighting neurologic involvement and responses to ALK inhibition. Blood 2022; 139: 256-280
• 64 Lu LX, Della-Torre E, Stone JH. et al. IgG4-related hypertrophic pachymeningitis: clinical features, diagnostic criteria, and treatment. JAMA Neurol 2014; 71: 785-793
• 65 Kretowska-Grunwald A, Krawczuk-Rybak M, Sawicka-Zukowska M. Intravenous immunoglobulin-induced aseptic meningitis – a narrative review of the diagnostic process, pathogenesis, preventative measures and treatment. J Clin Med 2022; 11: 3571
• 66 Kurokawa R, Ota Y, Gonoi W. et al. MRI findings of immune checkpoint inhibitor-induced hypophysitis: possible association with fibrosis. AJNR Am J Neuroradiol 2020; 41: 1683-1689
• 67 Dubey D, David WS, Amato AA. et al. Varied phenotypes and management of immune checkpoint inhibitor-associated neuropathies. Neurology 2019; 93: e1093-e1103
• 68 Karia SJ, Rykken JB, McKinney ZJ. et al. Utility and significance of gadolinium-based contrast enhancement in posterior reversible encephalopathy syndrome. AJNR Am J Neuroradiol 2016; 37: 415-422
• 69 Schievink WI. Spontaneous intracranial hypotension. N Engl J Med 2021; 385: 2173-2178
• 70 de Noronha RJ, Sharrack B, Hadjivassiliou M. et al. Subdural haematoma: a potentially serious consequence of spontaneous intracranial hypotension. J Neurol Neurosurg Psychiatry 2003; 74: 752-755
• 71 Kranz PG, Gray L, Amrhein TJ. Decubitus CT myelography for detecting subtle CSF leaks in spontaneous intracranial hypotension. AJNR Am J Neuroradiol 2019; 40: 754-756
• 72 Sekijima Y. Hereditary transthyretin amyloidosis. Seattle: University of Washington; 2021.
• 73 Velo M, Grasso G, Fujimura M. et al. Moyamoya vasculopathy: cause, clinical manifestations, neuroradiologic features, and surgical management. World Neurosurg 2022; 159: 409-425
• 74 Kamada F, Aoki Y, Narisawa A. et al. A genome-wide association study identifies RNF213 as the first Moyamoya disease gene. J Hum Genet 2011; 56: 34-40
• 75 Mori N, Mugikura S, Higano S. et al. The leptomeningeal “ivy sign” on fluid-attenuated inversion recovery MR imaging in Moyamoya disease: a sign of decreased cerebral vascular reserve?. AJNR Am J Neuroradiol 2009; 30: 930-935