Neuroimaging clinics of North America
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Infection of the central nervous system (CNS) in children is an important entity and early recognition is paramount to avoid long-term brain injury, especially in very young patients. The causal factors are different in children compared with adults and so are the clinical presentations. However, imaging features of CNS infection show similar features to those of adults. This article reviews some of the common types of pediatric infections, starting with the congenital (or in utero) infections followed by bacterial infections of the meninges and brain parenchyma.
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Infections of the spine represent a rare but potentially debilitating and neurologically devastating condition for patients. Early diagnosis, imaging, and intervention may prevent some of the more critical complications that may ensue from this disease process, including alignment abnormalities, central canal compromise, nerve root impingement, vascular complications, and spinal cord injury. This article reviews the underlying pathophysiologic basis of infection, clinical manifestations, and imaging modalities used to diagnose infections of the spine and spinal cord.
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In cases of central nervous system infection, it is crucial for the neuroradiologist to provide an accurate differential diagnosis of the possible pathogens involved so that treating physicians can be aided in the choice of empiric therapy. This approach requires the radiologist to be aware of local epidemiology and have knowledge of infectious agents that are endemic to their area of practice. This article reviews and discusses the changing epidemiology of pathogens most often observed in meningitis, brain abscess, epidural abscess, postoperative infections, and human immunodeficiency virus infection.
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Neurocysticercosis (NCC) is an infection of the central nervous system by the Taenia solium larvae, and is the most common cause of acquired epilepsy in endemic regions. The natural history of parenchymal NCC lesions can be divided into 4 stages with unique imaging and clinical features. Evaluation of cysticerci is challenging on conventional magnetic resonance (MR) imaging and computed tomography, and is significantly improved with MR cysternography techniques. Differentiation of NCC lesions from metastatic disease and pyogenic abscesses can be improved with advanced MR imaging including (1)H nuclear MR spectroscopy, diffusion-weighted imaging, and MR perfusion imaging.
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Radiology provides valuable gross pathologic information about central nervous system (CNS) infections. Major categories of infectious lesions of the brain and spinal cord are recognized by imaging such as diffuse, focal, or multifocal. ⋯ It illustrates examples with gross and microscopic photographs of CNS infections, and the tissue reactions to these infections. Where the organism can spread within the CNS, and cellular responses to the organism underlie both the radiographic and pathologic findings.