Synopsis
Neuroimaging plays a crucial role in the
diagnosis and therapeutic decision making in infectious diseases of the central
nervous system (CNS). Bacterial and fungal pathogens are derived from living
organisms and affect the brain, spinal cord, or meninges. Infections due to
these pathogens are associated with a variety of neuroimaging patterns. Bacterial
infection of the CNS is a life-threatening condition with a high mortality. Bacterial
infections, most often due to Streptococcus, Haemophilus, and Neisseria
species, cause significant meningitis, whereas the less common cerebritis and
subsequent abscess formation have well-documented progression, with
increasingly prominent altered signal intensity and corresponding contrast
enhancement. Atypical bacterial infections are characterized by the development
of a granulomatous response, classically seen in tuberculosis, in which the
tuberculoma is the most common parenchymal form of the disease. Fungal
infections of the CNS represent a wide spectrum of diseases with some common MRI
features. Risk factors include immunocompromise of any cause and living in
endemic areas. CNS infection occurs through hematogenous spread, cerebrospinal
fluid seeding, or direct extension. MRI features include heterogeneous or ring
reduced diffusion and weak ring enhancement. Angioinvasive aspergillosis is
characterized by multifocal hemorrhagic lesions with reduced diffusion.
Cryptococcosis results in gelatinous pseudocyst formation in the basal ganglia.
Mucormycosis is characterized by frontal lobe lesions with markedly reduced
diffusion. Candidiasis is usually manifest by numerous microabscesses of less
than 3 mm occurring at the corticomedullary junction, basal ganglia, or
cerebellum. Coccidioidomycosis often results in meningitis with contrast
enhancement of the basal cisterns. Blastomycosis and histoplasmosis are rare
infections with parenchymal abscesses or meningitis. Recognizing the imaging
features of CNS infections allows for early, aggressive treatment of these
otherwise rapidly fatal infections. This presentation aims at highlighting the
characteristic neuroimaging manifestations of bacterial, and fungal infections,
with emphasis on radiologic-pathologic correlation and historical perspectives.
Acknowledgements
No acknowledgement found.References
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