CNS Infections: Bacterial/Fungal
Seung Hong Choi1

1Radiology, Seoul National University

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

1. Shih RY, Koeller KK. Bacterial, Fungal, and Parasitic Infections of the Central Nervous System: Radiologic-Pathologic Correlation and Historical Perspectives: From the Radiologic Pathology Archives. Radiographics. 2015;35(4):1141-1169.

2. Starkey J, Moritani T, Kirby P. MRI of CNS fungal infections: review of aspergillosis to histoplasmosis and everything in between. Clin Neuroradiol. 2014;24(3):217-230.



Proc. Intl. Soc. Mag. Reson. Med. 24 (2016)
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