Imaging of Infections of the Brain and Meninges

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Congenital or Neonatal Infection

Transplacental, parturitional, and ascending cervical transmission can serve as routes of perinatal or neonatal CNS infection. Alternate routes of infection can occur during breastfeeding and blood transfusion. Commonly implicated pathogens in mother to child infection are the so-called TORCH infections [toxoplasmosis, rubella, cytomegalovirus (CMV) and herpes simplex virus (HSV)], human immunodeficiency virus (HIV) and group B Streptococcus.

CMV is a common, asymptomatic infection in the United

Extra Axial Infection

Although the more prevalent causative organisms vary widely by geographic location and age, Streptococcus pneumoniae and Neisseria meningitidis account for approximately 80% of all cases of bacterial meningitis in the United States.26, 27

Being a clinical and laboratory diagnosis, it is not surprising that the most common result of an unenhanced head CT is normal in proven bacterial meningitis.28, 29 Findings of hydrocephalus, subdural effusion or empyema, and venous thrombosis do portend a

Encephalitis, Cerebritis, and Abscess

HSV-1 is the most common cause of viral encephalitis40 and results from reactivation of latent trigeminal nerve or ganglion infection after initial oropharyngeal exposure.41 HSV-1 has a predilection for neurons resulting in a predominately cortical involvement classically involving the limbic system (and more specifically the medial temporal lobes, insula, subfrontal areas and cingulate gyri). HSV detection by polymerase chain reaction assay is the most sensitive and specific method to detect

Atypical Infection

Neurocysticercosis, an infection caused by the larva of Taenia solium, which is endemic in multiple continents, is a leading cause of acquired epilepsy worldwide.52 Seizure is the most common clinical sign of neurocysticercosis with symptoms of increased intracranial pressure either from mass effect from the intracranial lesion or associated edema, or possible resultant hydrocephalus.53

Although both human beings and pigs are intermediate hosts to T solium larvae, only human beings act as the

Postviral Syndrome

Acute disseminated encephalomyelitis (ADEM) is believed to be an immune-mediated demyelination which can involve both brain and spinal cord resulting in neurologic deficits.76, 77 Although ADEM can follow routine vaccination and has been reported after bacterial infection, the overwhelming number of cases occur days to weeks after a viral illness—most frequently measles, varicella, rubella, mumps, and influenza.76

The imaging is that of demyelination with hypoattenuation on CT, and

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