2001 ASNR Annual Meeting Abstracts

01-E-503-ASNR
Cat-Scratch Disease Neuroretinitis: MR Imaging
Findings
Widelec, J. * Sztern, B. * Peetrons, P.
Centre Hospitalier Molière-Longchamp, Brussels, Belgium

Purpose
To report the MR imaging aspect of the retina during the acute phase of ocular cat-scratch
disease (CSD) before and after treatment and to illustrate the link between the specific enzyme-
linked immunosorbent assay serologic test, the patient visual status, and the MR findings.

Material & Methods

A 18-year-old boy was refer to the emergency department for a rapid progressive unilateral
visual loss (3 days). The physical examination only revealed an unilateral eyelid edema located
on the same side of the visual loss. No other neurologic deficits were observed during the
physical examination. A sinus CT scan immediately was performed and was inconclusive. No
sinusal nor orbital infections were found. A MR study including the brain and the orbits was
performed. It showed a regular thickening of the retina which homogeneously enhanced after
gadolinium injection. No optic nerve or brain parenchymal lesions were found. Tuberculosis,
Lyme, toxoplasmosis, syphilis, and sarcoidosis were excluded. Serologic test for Bartonella
henselae was strongly positive (IgG 1/4000). The fundus showed a macular star pattern which
can be seen on CSD neuroretinitis. After adequate treatment, the patient recovered normal vision.
A control performed 3 months after the acute phase demonstrated an normal MR appearance of
the retina, a normalization of the serologic test, and the persistence of macular stars at the
fundus. The final presumed diagnosis was CSD neuroretinitis previously called Leber’s
idiopathic neuroretinitis.

Results
Bartonella henselae recently has been isolated and found to be the main cause of CSD. The
availability of specific serologic tests has allowed the recognition of a spectrum of ocular CSD
syndromes that previously were ill-defined and considered idiopathic. The main ocular
manifestations of CSD include anterior uveitis, focal retinal vasculitis, vascular occlusions,
retinal detachment, neuroretinitis, and optic neuritis. To our knowledge this abstract provides, for
the first time, the MR description of the CSD neuroretinitis characterized by a regular thickening
of the retina which strongly enhances after gadolinium injection and disappears after adequate
treatment. At the same time, the serologic investigations recover a normal level. Only the
abnormal fundus (macular star) may persist for a long time after the normal visual recovery.

Conclusion
We believe that this reversible retinal thickening constitutes a new sign of involvement in case of
ocular CSD and becomes specific in association with the serologic tests in order to detect
antibodies against Bartonella henselae.
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