Brain (CNS) Infection ImagingBrain (CNS) Infection Imaging

Jalal Jalal Shokouhi – M.D.Jalal Jalal Shokouhi – M.D.Secretary of Iranian society of radiologySecretary of Iranian society of radiologyCooperation of Iranian radiologist, presidentCooperation of Iranian radiologist, president

Jalaljalalshokouhi@hotmail.com www.Medimage.ir

Brain infection:1. Ever-growing,worldwide public health problem2. Age-old: TB, Malaria, more lethal due to

multidrug-resistant strains3. HIV is different face4. New diseases with no known vaccine (ebola,

biohazard level 4 agents)5. Wide spread immigrations6. World wide influenza (pandemic)

Radiology 1.TORCH agents

Congenital CMV Congenital HIV Congenital herpes

2.Aquired infections Group B streptococcal meningitis Citrobacter meningitis Meningitis Abscess Ventriculitis Empyema Herpes encephalitis Encephalitis(miscellaneous) Rasmussen encephalitis TB

NeurocysticercosisParasitesFungalRickettsialLymeHIV encephalitisOpportunistic infection AIDS

3.Demyelinating diseases

MSADEMSubacute sclerosing panencephalitis

DDx: Neonatal Periventricular CalcificationDDx: Neonatal Periventricular Calcification

Congenital CMV

Toxoplasmosis LCM Pseudo-TORCHCMV

Microcephaly Ca++ 40-70%Gyral changesCerebellar hypoplasiaHydrocephalyHypodensitiesAbnormal WM

CMV

Congenital HIV

HIV

AtrophyBG Ca++Aneurysmal changes (vasculopathy)

DDx: Childhood Brain Ca++

CMVCMV Toxoplasmosis

Congenital HIV DDx

Congenital HerpesCongenital Herpes

Severe atrophyBG Ca++HemorrhageHydrocephalyMRS changes

CMV

DDx: TORCH

Toxoplasma+CMV Toxoplasmosis

Congenital herpes

Group B Streptococcal MeningitisHydrocephalyHypo dense artery territorial(stenosis)Hemoragic venus infarctSubdurl empyemaRim enhancement Abscess

DDx: Neonatal Meningoencephalitis

E.Coli

Citrobacter

HSV 2

Group B Streptococcal Meningitis

Group B Streptococcal Meningitis

Citrobacter Meningitis

DDx: DDx: Pediatric Cavitary White Matter Lessions

Pyogenic Abcess Encephalomalacia NAHI & WM Tears

Cerebritis Abscess squareLobar cavityMarginal, septal enhancement

Citrobacter Meningitis

Meningitis

DDx: Leptomeningeal Disease

Metastasis Neurosarcoidosis SAH MCA infarct

NormalHydrocephalyBasal cistern involvementArterial narrowingsExudate enhancementCerebral edema, infarct

Meningitis

Abscess

DDx: Ring-enhancing Lesions

Primary tumor

Resolving Clot

Demyelination

Metastasis

Early cerebritisLate cerebritisEarly cap.Late cap.CavityWall enhancement

Abscess

Ventriculitis

•Ventriculomegaly with debries•Enhanced ependyma

Empyema

DDx: Extra-axial Lesions

Chronic Hematoma Subdural Effusions Subdural Hygroma Dural Metastases

Extra-axial collectionBilateralRim enhancement

Herpes Encephalitis

Temporal Lobe Lesions

Status EpilepticusGliomatosis Cerebri

MCA IschemiaLimbic Encephalitis

NormalHypodensityBitemporal signals(Flair, T2)Patchy or Gyral enhancemnet or No

Herpes Encephalitis

Encephalitis (Miscellaneous)

DDx: Diffuse Parenchymal Lesions

ACA, MCA Ischemia Astrocytoma Herpes Encephalitis Status Epilepticus

NormalHigh signal T1High signal T2,Flair

Rasmussen Encephalitis

Sturge Weber Dyke Mason MELAS

Atrophy, hydrocephalyNo enhancementGyral swellingSignal change: edema

DDx: Cerebral Hemiatrophy

Tuberculosis

DDx: Intracranial TB (Meningeal, Parenchymal)

Bacterial Meningitis

NeurosarcoidosisPyogenic Abscess

Primary Glioma (GBM)

NormalBasal cistern thick enhancementTuberculomaCa++EnhancementSOL (rare)

Tuberculosis

Neurocysticercosis

DDx: Ring-enhancing Parenchymal Lesions

Tuberculoma

Pyogenic Abscess Metastases

Amebic Encephalitis

HydrocephalyRing enhancementsCyst and nidus insideCa++ granularGranular, vesicular patterns

Neurocysticercosis

Parasites, Miscellaneous

DDx: Ring-enhancing Parenchymal Lesions

Matastatic Disease

Cystic GBM Pyogenic Abscess

Neurocysticercosis

•Hydatid= simple cyst,no enhancement•Amebic=complex, cystic hypodensities

Parasites, Miscellaneous

Malaria Malaria

Paragonimiasis Paragonimiasis

Fugal Disease

DDx: Multiple Enhancing Brain Lesions in Immunosuppressed Patients

Cysticercosis MetastasesTB Septic Emboli

GranularLacunar, cysticEdemaHemorrhagehydrocephaly

Nocardiosis

Rickettsial Disease

DDx: Multifocal White Matter Lesions

M. Sclerosis

Vasculitis

Sarcoidosis

Herpes Simplex 1

Small WM lesionsMay enhancedBrain edemaCaudia equina enhancement

Lyme DiseaseLyme Disease

DDx: Common White Matter Hyperintensities

SarcoidosisMS Lacunar InfarctVasculitis

•UBO periventricular•Faint enhancement

HIV Encephalitis

LymphomaPML HSV Encephalitis

DDx: Focal White Matter Abnormalities in HIV+

HHV6 Encephalitis

Children•Atrophy•WM disease•BG Ca++

Adult•Atrophy ,hydrocephaly•No enhancement

HIV Encephalitis

Opportunistic Infection, AIDS

Focal Mass in HIV+

Primary Lymphoma Bacterial AbscessesToxo.

Hyperdense, Hypodense, Hyperintense related to:TB, PML, Toxo, Lymphoma

Opportunistic Infection, AIDS

CryptococcusPML: progressive multi

focal leukoencephalopathy TB

Multiple Sclerosis

ADEM Vasculitis Lyme Disease Susac Syndrome

Multiple Sclerosis

ADEM: Acute disseminated encephalomyelitis

DDx: Multifocal White Matter Lesions

MS Aging WM Lesions Fabry Disease Behcet

UBO`s with coalescence Centri petalSOL

ADEM

Subacute Sclerosing Panencephalitis

DDx: Confluent T2 Hyperintense White Matter Lesions

ADEM PML MS HIV

•Patchy signals•Brain edema

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