Imaging in adult patients with acute febrile encephalopathy: What is better, computerized tomography (CT) or magnetic resonance imaging (MRI)?

Abstract

Objective: To compare the efficacy of cranial imaging techniques in adult patients with acute febrile encephalopathy. Methods: We enrolled one hundred and two patients presenting to the emergency with fever of shorter than 15-day duration and altered sensorium. All the patients were subjected to routine investigations, detailed cerebrospinal fluid analysis, computerized tomograms (Non contrast followed by contrast enhanced) and Magnetic resonance imaging of the brain. Final diagnosis was reached after considering the clinical, biochemical findings, imaging results and response to therapy. The positive yield of radiological investigations was compared against the final diagnosis. Results: The patients were divided into three groups. Of these patients, 48 had evidence of meningoencephalitis, 22 patients had pyogenic meningitis, and 20 were combined together in others group. In other 12 patients, a definitive diagnosis could not be made. Only 37% patients were detected to have abnormal computerized tomograms and the commonest abnormality was diffuse edema, which failed to point to an etiological diagnosis. Magnetic resonance imaging was abnormal in 62.75% cases and was able to suggest an etiological diagnosis in 100% cases of cerebral venous thrombosis, tubercular meningitis, 95% cases of meningoencephalitis and 45% with meningitis. Conclusions: Magnetic resonance imaging provides better information than computerized tomography in adult patients with acute febrile encephalopathy.

Keywords

• Acute febrile illness
• Encephalopathy
• Encephalitis
• Meningoencephalitis
• Magnetic resonance imaging
• CT scan