Skip to main content
Top
Published in: Current Neurology and Neuroscience Reports 6/2017

01-06-2017 | Infection (J Halperin, Section Editor)

Neuroimaging in Central Nervous System Infections

Authors: Nathaniel C. Swinburne, Anmol G. Bansal, Amit Aggarwal, Amish H. Doshi

Published in: Current Neurology and Neuroscience Reports | Issue 6/2017

Login to get access

Abstract

Radiologic imaging is often employed to supplement clinical evaluation in cases of suspected central nervous system (CNS) infection. While computed tomography (CT) is superior for evaluating osseous integrity, demineralization, and erosive changes and may be more readily available at many institutions, magnetic resonance imaging (MRI) has significantly greater sensitivity for evaluating the cerebral parenchyma, cord, and marrow for early changes that have not yet reached the threshold for CT detection. For these reasons, MRI is generally superior to CT for characterizing bacterial, viral, fungal, and parasitic infections of the CNS. The typical imaging features of common and uncommon CNS infectious processes are reviewed.
Literature
3.
go back to reference Chaudhuri A, Martin PM, Kennedy PGE, Andrew Seaton R, Portegies P, Bojar M, et al. EFNS guideline on the management of community-acquired bacterial meningitis: report of an EFNS Task Force on acute bacterial meningitis in older children and adults. Eur J Neurol. 2008;15:649–59. doi:10.1111/j.1468-1331.2008.02193.x.CrossRefPubMed Chaudhuri A, Martin PM, Kennedy PGE, Andrew Seaton R, Portegies P, Bojar M, et al. EFNS guideline on the management of community-acquired bacterial meningitis: report of an EFNS Task Force on acute bacterial meningitis in older children and adults. Eur J Neurol. 2008;15:649–59. doi:10.​1111/​j.​1468-1331.​2008.​02193.​x.CrossRefPubMed
4.
5.
go back to reference van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med. 2004;351(18):1849–59. doi:10.1056/NEJMoa040845.CrossRefPubMed van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med. 2004;351(18):1849–59. doi:10.​1056/​NEJMoa040845.CrossRefPubMed
9.
go back to reference Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39:1267–84. doi:10.1086/425368.CrossRefPubMed Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39:1267–84. doi:10.​1086/​425368.CrossRefPubMed
11.
go back to reference • Vaswani A, Nizamani W, Ali M, Aneel G, Shahani B, Hussain S. Diagnostic accuracy of contrast-enhanced FLAIR magnetic resonance imaging in diagnosis of meningitis correlated with CSF analysis. ISRN Radiol. 2014;2014:578986. doi:10.1155/2014/578986. Vaswani et al. prospectively evaluated 57 patients with suspected meningitis who underwent brain MRI. Using positive CSF analysis as the gold standard, the authors found that post-contrast FLAIR had superior sensitivity (96%) and specificity (85.7%) as compared with post-contrast T1 imaging. CrossRefPubMedPubMedCentral • Vaswani A, Nizamani W, Ali M, Aneel G, Shahani B, Hussain S. Diagnostic accuracy of contrast-enhanced FLAIR magnetic resonance imaging in diagnosis of meningitis correlated with CSF analysis. ISRN Radiol. 2014;2014:578986. doi:10.​1155/​2014/​578986. Vaswani et al. prospectively evaluated 57 patients with suspected meningitis who underwent brain MRI. Using positive CSF analysis as the gold standard, the authors found that post-contrast FLAIR had superior sensitivity (96%) and specificity (85.7%) as compared with post-contrast T1 imaging. CrossRefPubMedPubMedCentral
17.
go back to reference Mishra AM, Gupta RK, Jaggi RS, Reddy JS, Jha DK, Husain N, et al. Role of diffusion-weighted imaging and in vivo proton magnetic resonance spectroscopy in the differential diagnosis of ring-enhancing intracranial cystic mass lesions. J Comput Assist Tomogr. 2004;28:540–7.CrossRefPubMed Mishra AM, Gupta RK, Jaggi RS, Reddy JS, Jha DK, Husain N, et al. Role of diffusion-weighted imaging and in vivo proton magnetic resonance spectroscopy in the differential diagnosis of ring-enhancing intracranial cystic mass lesions. J Comput Assist Tomogr. 2004;28:540–7.CrossRefPubMed
18.
go back to reference Dorenbeck U, Butz B, Schlaier J, Bretschneider T, Schuierer G, Feuerbach S. Diffusion-weighted echo-planar MRI of the brain with calculated ADCs: a useful tool in the differential diagnosis of tumor necrosis from abscess? Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging. 2003;13:330–8.CrossRef Dorenbeck U, Butz B, Schlaier J, Bretschneider T, Schuierer G, Feuerbach S. Diffusion-weighted echo-planar MRI of the brain with calculated ADCs: a useful tool in the differential diagnosis of tumor necrosis from abscess? Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging. 2003;13:330–8.CrossRef
19.
go back to reference Erdogan C, Hakyemez B, Yildirim N, Parlak M. Brain abscess and cystic brain tumor: discrimination with dynamic susceptibility contrast perfusion-weighted MRI. J Comput Assist Tomogr. 2005;29(5):663–7.CrossRefPubMed Erdogan C, Hakyemez B, Yildirim N, Parlak M. Brain abscess and cystic brain tumor: discrimination with dynamic susceptibility contrast perfusion-weighted MRI. J Comput Assist Tomogr. 2005;29(5):663–7.CrossRefPubMed
21.
go back to reference Carpenter JL. Brain stem abscesses: cure with medical therapy, case report, and review. Clin Infect Dis. 1994;18(2):219–26.CrossRefPubMed Carpenter JL. Brain stem abscesses: cure with medical therapy, case report, and review. Clin Infect Dis. 1994;18(2):219–26.CrossRefPubMed
24.
go back to reference Bakshi R, Wright PD, Kinkel PR, Bates VE, Mechtler LL, Kamran S, et al. Cranial magnetic resonance imaging findings in bacterial endocarditis: the neuroimaging spectrum of septic brain embolization demonstrated in twelve patients. J Neuroimaging. 1999;9(2):78–84.CrossRefPubMed Bakshi R, Wright PD, Kinkel PR, Bates VE, Mechtler LL, Kamran S, et al. Cranial magnetic resonance imaging findings in bacterial endocarditis: the neuroimaging spectrum of septic brain embolization demonstrated in twelve patients. J Neuroimaging. 1999;9(2):78–84.CrossRefPubMed
25.
27.
go back to reference Thurnher MM, Schindler EG, Thurnher SA, Pernerstorfer-Schon H, Kleibl-Popov C, Rieger A. Highly active antiretroviral therapy for patients with AIDS dementia complex: effect on MR imaging findings and clinical course. AJNR Am J Neuroradiol. 2000;21(4):670–8.PubMed Thurnher MM, Schindler EG, Thurnher SA, Pernerstorfer-Schon H, Kleibl-Popov C, Rieger A. Highly active antiretroviral therapy for patients with AIDS dementia complex: effect on MR imaging findings and clinical course. AJNR Am J Neuroradiol. 2000;21(4):670–8.PubMed
28.
go back to reference Chang L, Ernst T, Leonido-Yee M, Witt M, Speck O, Walot I, et al. Highly active antiretroviral therapy reverses brain metabolite abnormalities in mild HIV dementia. Neurology. 1999;53(4):782–9.CrossRefPubMed Chang L, Ernst T, Leonido-Yee M, Witt M, Speck O, Walot I, et al. Highly active antiretroviral therapy reverses brain metabolite abnormalities in mild HIV dementia. Neurology. 1999;53(4):782–9.CrossRefPubMed
29.
go back to reference Ragin AB, Storey P, Cohen BA, Epstein LG, Edelman RR. Whole brain diffusion tensor imaging in HIV-associated cognitive impairment. AJNR Am J Neuroradiol. 2004;25(2):195–200.PubMedPubMedCentral Ragin AB, Storey P, Cohen BA, Epstein LG, Edelman RR. Whole brain diffusion tensor imaging in HIV-associated cognitive impairment. AJNR Am J Neuroradiol. 2004;25(2):195–200.PubMedPubMedCentral
30.
go back to reference Filippi CG, Ulug AM, Ryan E, Ferrando SJ, van Gorp W. Diffusion tensor imaging of patients with HIV and normal-appearing white matter on MR images of the brain. AJNR Am J Neuroradiol. 2001;22(2):277–83.PubMed Filippi CG, Ulug AM, Ryan E, Ferrando SJ, van Gorp W. Diffusion tensor imaging of patients with HIV and normal-appearing white matter on MR images of the brain. AJNR Am J Neuroradiol. 2001;22(2):277–83.PubMed
31.
go back to reference Post MJ, Yiannoutsos C, Simpson D, Booss J, Clifford DB, Cohen B, et al. Progressive multifocal leukoencephalopathy in AIDS: are there any MR findings useful to patient management and predictive of patient survival? AIDS Clinical Trials Group, 243 Team. AJNR Am J Neuroradiol. 1999;20(10):1896–906.PubMed Post MJ, Yiannoutsos C, Simpson D, Booss J, Clifford DB, Cohen B, et al. Progressive multifocal leukoencephalopathy in AIDS: are there any MR findings useful to patient management and predictive of patient survival? AIDS Clinical Trials Group, 243 Team. AJNR Am J Neuroradiol. 1999;20(10):1896–906.PubMed
35.
go back to reference Obeid M, Franklin J, Shrestha S, Johnson L, Quattromani F, Hurst D. Diffusion-weighted imaging findings on MRI as the sole radiographic findings in a child with proven herpes simplex encephalitis. Pediatr Radiol. 2007;37(11):1159–62. doi:10.1007/s00247-007-0577-z.CrossRefPubMed Obeid M, Franklin J, Shrestha S, Johnson L, Quattromani F, Hurst D. Diffusion-weighted imaging findings on MRI as the sole radiographic findings in a child with proven herpes simplex encephalitis. Pediatr Radiol. 2007;37(11):1159–62. doi:10.​1007/​s00247-007-0577-z.CrossRefPubMed
39.
go back to reference Luthra G, Parihar A, Nath K, Jaiswal S, Prasad KN, Husain N, et al. Comparative evaluation of fungal, tubercular, and pyogenic brain abscesses with conventional and diffusion MR imaging and proton MR spectroscopy. AJNR Am J Neuroradiol. 2007;28(7):1332–8. doi:10.3174/ajnr.A0548.CrossRefPubMed Luthra G, Parihar A, Nath K, Jaiswal S, Prasad KN, Husain N, et al. Comparative evaluation of fungal, tubercular, and pyogenic brain abscesses with conventional and diffusion MR imaging and proton MR spectroscopy. AJNR Am J Neuroradiol. 2007;28(7):1332–8. doi:10.​3174/​ajnr.​A0548.CrossRefPubMed
40.
go back to reference Moore SL, Rafii M. Imaging of musculoskeletal and spinal tuberculosis. Radiol Clin N Am. 2001;39(2):329–42.CrossRefPubMed Moore SL, Rafii M. Imaging of musculoskeletal and spinal tuberculosis. Radiol Clin N Am. 2001;39(2):329–42.CrossRefPubMed
41.
go back to reference Ramsey RG, Gean AD. Neuroimaging of AIDS. I. Central nervous system toxoplasmosis. Neuroimaging Clin N Am. 1997;7(2):171–86.PubMed Ramsey RG, Gean AD. Neuroimaging of AIDS. I. Central nervous system toxoplasmosis. Neuroimaging Clin N Am. 1997;7(2):171–86.PubMed
42.
go back to reference • Saini J, Gupta RK, Jain KK. Intracranial infections: key neuroimaging findings. Semin Roentgenol. 2014;49(1):86–98. doi:10.1053/j.ro.2013.09.001. Saini et al. discuss the key neuroimaging findings, including advanced techniques, of not only commonly encountered CNS infections but also of many additional entities, especially of viral etiology, that are not as commonly seen. CrossRefPubMed • Saini J, Gupta RK, Jain KK. Intracranial infections: key neuroimaging findings. Semin Roentgenol. 2014;49(1):86–98. doi:10.​1053/​j.​ro.​2013.​09.​001. Saini et al. discuss the key neuroimaging findings, including advanced techniques, of not only commonly encountered CNS infections but also of many additional entities, especially of viral etiology, that are not as commonly seen. CrossRefPubMed
43.
go back to reference Smith AB, Smirniotopoulos JG, Rushing EJ. From the archives of the AFIP: central nervous system infections associated with human immunodeficiency virus infection: radiologic-pathologic correlation. Radiographics. 2008;28(7):2033–58. doi:10.1148/rg.287085135.CrossRefPubMed Smith AB, Smirniotopoulos JG, Rushing EJ. From the archives of the AFIP: central nervous system infections associated with human immunodeficiency virus infection: radiologic-pathologic correlation. Radiographics. 2008;28(7):2033–58. doi:10.​1148/​rg.​287085135.CrossRefPubMed
44.
go back to reference Bhagavati S, Choi J. Frequent hemorrhagic lesions in cerebral toxoplasmosis in AIDS patients. J Neuroimaging. 2009;19(2):169–73.CrossRefPubMed Bhagavati S, Choi J. Frequent hemorrhagic lesions in cerebral toxoplasmosis in AIDS patients. J Neuroimaging. 2009;19(2):169–73.CrossRefPubMed
46.
go back to reference Mueller-Mang C, Mang TG, Kalhs P, Thurnher MM. Imaging characteristics of toxoplasmosis encephalitis after bone marrow transplantation: report of two cases and review of the literature. Neuroradiology. 2006;48(2):84–9. doi:10.1007/s00234-005-0018-3.CrossRefPubMed Mueller-Mang C, Mang TG, Kalhs P, Thurnher MM. Imaging characteristics of toxoplasmosis encephalitis after bone marrow transplantation: report of two cases and review of the literature. Neuroradiology. 2006;48(2):84–9. doi:10.​1007/​s00234-005-0018-3.CrossRefPubMed
47.
go back to reference Ionita C, Wasay M, Balos L, Bakshi R. MR imaging in toxoplasmosis encephalitis after bone marrow transplantation: paucity of enhancement despite fulminant disease. AJNR Am J Neuroradiol. 2004;25(2):270–3.PubMed Ionita C, Wasay M, Balos L, Bakshi R. MR imaging in toxoplasmosis encephalitis after bone marrow transplantation: paucity of enhancement despite fulminant disease. AJNR Am J Neuroradiol. 2004;25(2):270–3.PubMed
48.
go back to reference Simone IL, Federico F, Tortorella C, Andreula CF, Zimatore GB, Giannini P, et al. Localised 1H-MR spectroscopy for metabolic characterisation of diffuse and focal brain lesions in patients infected with HIV. J Neurol Neurosurg Psychiatry. 1998;64(4):516–23.CrossRefPubMedPubMedCentral Simone IL, Federico F, Tortorella C, Andreula CF, Zimatore GB, Giannini P, et al. Localised 1H-MR spectroscopy for metabolic characterisation of diffuse and focal brain lesions in patients infected with HIV. J Neurol Neurosurg Psychiatry. 1998;64(4):516–23.CrossRefPubMedPubMedCentral
51.
go back to reference Braga F, Rocha AJ, Gomes HR, Filho GH, Silva CJ, Fonseca RB. Noninvasive MR cisternography with fluid-attenuated inversion recovery and 100% supplemental O(2) in the evaluation of neurocysticercosis. AJNR Am J Neuroradiol. 2004;25(2):295–7.PubMed Braga F, Rocha AJ, Gomes HR, Filho GH, Silva CJ, Fonseca RB. Noninvasive MR cisternography with fluid-attenuated inversion recovery and 100% supplemental O(2) in the evaluation of neurocysticercosis. AJNR Am J Neuroradiol. 2004;25(2):295–7.PubMed
53.
go back to reference Andreula CF, Burdi N, Carella A. CNS cryptococcosis in AIDS: spectrum of MR findings. J Comput Assist Tomogr. 1993;17(3):438–41.CrossRefPubMed Andreula CF, Burdi N, Carella A. CNS cryptococcosis in AIDS: spectrum of MR findings. J Comput Assist Tomogr. 1993;17(3):438–41.CrossRefPubMed
54.
go back to reference Castillo M. Brain infections in human immunodeficiency virus positive patients. Top Magn Reson Imaging. 1994;6(1):3–10.PubMed Castillo M. Brain infections in human immunodeficiency virus positive patients. Top Magn Reson Imaging. 1994;6(1):3–10.PubMed
55.
go back to reference Berkefeld J, Enzensberger W, Lanfermann H. Cryptococcus meningoencephalitis in AIDS: parenchymal and meningeal forms. Neuroradiology. 1999;41(2):129–33.CrossRefPubMed Berkefeld J, Enzensberger W, Lanfermann H. Cryptococcus meningoencephalitis in AIDS: parenchymal and meningeal forms. Neuroradiology. 1999;41(2):129–33.CrossRefPubMed
56.
go back to reference Tien RD, Chu PK, Hesselink JR, Duberg A, Wiley C. Intracranial cryptococcosis in immunocompromised patients: CT and MR findings in 29 cases. AJNR Am J Neuroradiol. 1991;12(2):283–9.PubMed Tien RD, Chu PK, Hesselink JR, Duberg A, Wiley C. Intracranial cryptococcosis in immunocompromised patients: CT and MR findings in 29 cases. AJNR Am J Neuroradiol. 1991;12(2):283–9.PubMed
57.
go back to reference • Offiah CE, Naseer A. Spectrum of imaging appearances of intracranial cryptococcal infection in HIV/AIDS patients in the anti-retroviral therapy era. Clin Radiol. 2016;71(1):9–17. doi:10.1016/j.crad.2015.10.005. Offiah and Naseer reviewed the MRIs of HIV/AIDs patients with confirmed CNS cryptococcal infection and have collated the constellation of varied imaging appearances associated with this diagnosis and how these appearances have evolved significantly in the post-HAART era. CrossRefPubMed • Offiah CE, Naseer A. Spectrum of imaging appearances of intracranial cryptococcal infection in HIV/AIDS patients in the anti-retroviral therapy era. Clin Radiol. 2016;71(1):9–17. doi:10.​1016/​j.​crad.​2015.​10.​005. Offiah and Naseer reviewed the MRIs of HIV/AIDs patients with confirmed CNS cryptococcal infection and have collated the constellation of varied imaging appearances associated with this diagnosis and how these appearances have evolved significantly in the post-HAART era. CrossRefPubMed
59.
go back to reference King MD, Perlino CA, Cinnamon J, Jernigan JA. Paradoxical recurrent meningitis following therapy of cryptococcal meningitis: an immune reconstitution syndrome after initiation of highly active antiretroviral therapy. Int J STD AIDS. 2002;13(10):724–6. doi:10.1258/095646202760326516.CrossRefPubMed King MD, Perlino CA, Cinnamon J, Jernigan JA. Paradoxical recurrent meningitis following therapy of cryptococcal meningitis: an immune reconstitution syndrome after initiation of highly active antiretroviral therapy. Int J STD AIDS. 2002;13(10):724–6. doi:10.​1258/​0956462027603265​16.CrossRefPubMed
60.
go back to reference Post MJ, Thurnher MM, Clifford DB, Nath A, Gonzalez RG, Gupta RK, et al. CNS-immune reconstitution inflammatory syndrome in the setting of HIV infection, part 1: overview and discussion of progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome and cryptococcal-immune reconstitution inflammatory syndrome. AJNR Am J Neuroradiol. 2013;34(7):1297–307. doi:10.3174/ajnr.A3183.CrossRefPubMed Post MJ, Thurnher MM, Clifford DB, Nath A, Gonzalez RG, Gupta RK, et al. CNS-immune reconstitution inflammatory syndrome in the setting of HIV infection, part 1: overview and discussion of progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome and cryptococcal-immune reconstitution inflammatory syndrome. AJNR Am J Neuroradiol. 2013;34(7):1297–307. doi:10.​3174/​ajnr.​A3183.CrossRefPubMed
61.
go back to reference Mendonca RA, Martins G, Lugokenski R, Rossi MD. Subacute spongiform encephalopathies. Top Magn Reson Imaging. 2005;16(2):213–9.CrossRefPubMed Mendonca RA, Martins G, Lugokenski R, Rossi MD. Subacute spongiform encephalopathies. Top Magn Reson Imaging. 2005;16(2):213–9.CrossRefPubMed
63.
go back to reference Ukisu R, Kushihashi T, Tanaka E, Baba M, Usui N, Fujisawa H, et al. Diffusion-weighted MR imaging of early-stage Creutzfeldt-Jakob disease: typical and atypical manifestations. Radiographics. 2006;26(Suppl 1):S191–204. doi:10.1148/rg.26si065503.CrossRefPubMed Ukisu R, Kushihashi T, Tanaka E, Baba M, Usui N, Fujisawa H, et al. Diffusion-weighted MR imaging of early-stage Creutzfeldt-Jakob disease: typical and atypical manifestations. Radiographics. 2006;26(Suppl 1):S191–204. doi:10.​1148/​rg.​26si065503.CrossRefPubMed
64.
65.
go back to reference Young GS, Geschwind MD, Fischbein NJ, Martindale JL, Henry RG, Liu S, et al. Diffusion-weighted and fluid-attenuated inversion recovery imaging in Creutzfeldt-Jakob disease: high sensitivity and specificity for diagnosis. AJNR Am J Neuroradiol. 2005;26(6):1551–62.PubMed Young GS, Geschwind MD, Fischbein NJ, Martindale JL, Henry RG, Liu S, et al. Diffusion-weighted and fluid-attenuated inversion recovery imaging in Creutzfeldt-Jakob disease: high sensitivity and specificity for diagnosis. AJNR Am J Neuroradiol. 2005;26(6):1551–62.PubMed
Metadata
Title
Neuroimaging in Central Nervous System Infections
Authors
Nathaniel C. Swinburne
Anmol G. Bansal
Amit Aggarwal
Amish H. Doshi
Publication date
01-06-2017
Publisher
Springer US
Published in
Current Neurology and Neuroscience Reports / Issue 6/2017
Print ISSN: 1528-4042
Electronic ISSN: 1534-6293
DOI
https://doi.org/10.1007/s11910-017-0756-8

Other articles of this Issue 6/2017

Current Neurology and Neuroscience Reports 6/2017 Go to the issue

Nerve and Muscle (LH Weimer, Section Editor)

Update on Chemotherapy-Induced Peripheral Neuropathy