Meningitis, Spine

This is a case of leptomeningitis secondary to listerioris in a 62-year-old female. The first and second images, pre- and postcontrast sagittal T1-weighted sequences, demonstrate diffuse leptomeningeal thickening and enhancement in the cervical, thoracic, and lumbar spinal regions. These findings are confirmed on the axial cervical and thoracic spinal sections, images 3 and 4. Within the lumbar spine, there is not only thickening and enhancement of the leptomeninges but also evidence of acrachnoiditis with thickening, clumping, and distortion/tethering of the cauda equina. The inflammatory reaction to the bacterial pathogens results in tight junction opening of the endothelial cells, allowing the pathogens access to the leptomeningeal surfaces. The differential diagnosis for diffuse leptomeningeal enhancement includes infection, subarachnoid hemorrhage, metastases, granulomatous inflammation and infarction.