Professional Documents
Culture Documents
Parenchymal Infections
I. PYOGENIC CEREBRITIS & ABSCESS
Anaerobic bacteria are the most common
organisms.
Infection with Staphylococcus aureus is common
after surgery or trauma.
Gram-negative rod, pneumococcal, streptococcal,
listerial, nocardial, and actinomycotic infections
Hematogenous spread Frontal and parietal
lobes (MCA distribution)
Sinus infections Frontal lobes
Otomastoiditis Temporal lobe or cerebellum
Early Cerebritis
Early Cerebritis
Within the first few days of infection, the
infected portion of brain is swollen and
edematous. Areas of necrosis are filled with
polymorphonuclear leukocytes, lymphocytes, and
plasma cells. Organisms are present in both the
center and the periphery of the lesion, which has
ill-defined margins.
CT scans may be normal or show an area of low
density (Fig. 6.1A arrowhead on the left frontal
lobe). There may be mild mass effect and patchy
areas of enhancement within the lesion.
Late Cerebritis
Early Capsule
Early Capsule
Within 2 weeks, the infection is walled off as a
capsule of collagen and reticulin forms in the
inflammatory, vascular margin of the
infection. Macrophages, phagocytes, and
neutrophils are also present in the capsule.
The necrotic center contains very few
organisms. Contrast-enhanced CT and MR
scans show a well defined rim of
enhancement (Fig. 6.1D).
Late Capsule
Septic Embolus
Multiple Tuberculoma
Tuberculous Abscess
Cysticercosis
When the cyst dies, the fluid within it leaks into the
surrounding brain, causing inflammation. This produces
clinical symptoms of an acute encephalitis, which may be
severe, depending on the number of lesions.
Imaging studies now reveal ring-enhancing lesions with
surrounding edema (Fig. 6.9). The cyst fluid is of increased
density on CT and increased signal compared with CSF on
T2W and T1W MR (Fig B & C). As the dead cyst
degenerates, it becomes smaller, showing nodular
enhancement, and then calcifies. CT scans at this late stage
show small, peripheral calcifications, with no edema or
enhancement (Fig. 6.10/D). Imaging with CT or MR is useful
in staging and monitoring treatment. Once the cyst has
degenerated, further drug therapy is not warranted.
Intraventricular Cysticercosis
Toxoplasmosis
Spirochete Infections
Viral Infections
The most common viral infections of the CNS
include CMV, herpes simplex, and HIV.
Cytomegalovirus
Herpes Simplex
Herpes Simplex
Herpes Simplex
FIGURE 6.19. Type 1 Herpes Encephalitis. The contrastenhanced CT scan (A) on this 8-year-old boy with decreased
level of consciousness reveals subtle low density in the right
temporal lobe (arrowheads). T2W fast fluid-attenuated
inversion recovery scans {MRI} (B, C) performed on the same
day show prominent areas of high signal intensity in both
temporal lobes with sparing of the putamen. This case
illustrates why MR is the imaging modality of choice when
herpes encephalitis is suspected.
EXTRA-AXIAL INFECTIONS
Meningitis
Bacterial Meningitis
Tuberculous Meningitis
Fungal Meningitis
FIGURE 6.25. Coccidioidomycosis Meningitis. Contrastenhanced, T1W axial (A) and coronal (B) scans reveal
abnormal enhancement of the meninges in the basal
cisterns (arrowheads).
Fungal meningitis usually causes thick meningeal
enhancement in the basal cisterns, as with tuberculosis (Fig.
6.25). Enhancement is variable (with cryptococcosis),
depending on the immune status of the patient.
Hydrocephalus is common, but infarcts and extension of
fungal meningitis into the brain occur less frequently than
with tuberculous or pyogenic meningitis (except in cases of
aspergillosis and mucormycosis).
HIV Encephalopathy
HIV is neurotropic
HIV patients are usually asymptomatic.
Pathologically, HIV infection results in
vacuolation of the white matter, with areas of
demyelination and multinucleated giant cells.
The cortical gray matter is usually spared.
AIDS dementia complex (ADC) is comprised of
subcortical dementia with cognitive,
behavioral, and motor deterioration (7-15%).
HIV Encephalopathy
Toxoplasmosis in AIDS
The
The typical appearance of CNS toxoplasmosis is that of multiple enhancing
mass lesions with surrounding vasogenic edema (Figs. 6.31). The lesions are
usually relatively small between 1 and 4 cm in diameter.
The basal ganglia are a favored site, but white matter and cortical lesions are
also common.
Bacterial abscesses are rare in AIDS patients.
FIGURE 6.31. Toxoplasmosis. A contrast-enhanced CT scan reveals bilateral
ring-enhancing lesions in the basal ganglia of this patient with AIDS. There is
marked surrounding low-density edema. The basal ganglia are a common site
for toxoplasmosis.