Neuroimaging of Infections of the Central Nervous System

ABSTRACT

Neuroimaging plays a crucial role in the diagnosis and therapeutic management of neurologic infections. This article summarizes imaging findings in brain abscesses, ventriculitis, viral diseases, and opportunistic infections. In cases of uncomplicated meningitis, cranial computed tomography is sufficient to exclude brain edema, hydrocephalus, and skull base pathology. Magnetic resonance imaging (MRI) is superior in depicting complications (e.g., empyema, vasculitis). Diffusion-weighted imaging (DWI) shows parenchymal complications of meningitis earlier and is of help in differentiation of pyogenic abscess from other ring-enhancing lesions. Proton magnetic resonance spectroscopy can produce specific peak-patterns in cases of abscess, such as the presence of lactate and cytosolic amino acids. In toxoplasmosis, DWI may help to differentiate from lymphoma, showing no restriction of water diffusion. In patients with viral encephalitis, DWI allows earlier lesion detection. MRI has revolutionized the rapid diagnosis of spinal abscess.

KEYWORDS

Neuroimaging - infections - therapy - MRI - diffusion-weighted imaging

REFERENCES

• 1 Tuncer O, Caksen H, Arslan S et al.. Cranial computed tomography in purulent meningitis of childhood.  Int J Neurosci. 2004;  114 167-174
• 2 Good C D, Jager H R. Contrast enhancement of the cerebrospinal fluid on MRI in two cases of spirochaetal meningitis.  Neuroradiology. 2000;  42 448-450
• 3 Kamra P, Azad R, Prasad K N, Jha S, Pradhan S, Gupta R K. Infectious meningitis: prospective evaluation with magnetisation transfer MRI.  Br J Radiol. 2004;  77 387-394
• 4 Soulie D, Meyer P, Raynaud M, Berge J, Dousset V. MRI and Listeria monocytogenes rhombencephalitis [in French].  J Radiol. 1996;  77 489-496
• 5 Al-Sous M W, Bohlega S, Al-Kawi M Z, Alwatban J, McLean D R. Neurobrucellosis: clinical and neuroimaging correlation.  AJNR Am J Neuroradiol. 2004;  25 395-401
• 6 Fukui M B, Williams R L, Mudigonda S. CT and MR imaging features of pyogenic ventriculitis.  AJNR Am J Neuroradiol. 2001;  22 1510-1516
• 7 Tsuchiya K, Osawa A, Katase S, Fujikawa A, Hachiya J, Aoki S. Diffusion-weighted MRI of subdural and epidural empyemas.  Neuroradiology. 2003;  45 220-223
• 8 Nguyen J B, Black B R, Leimkuehler M M, Halder V, Nguyen J V, Ahktar N. Intracranial pyogenic abscess: imaging diagnosis utilizing recent advances in computed tomography and magnetic resonance imaging.  Crit Rev Comput Tomogr. 2004;  45 181-224
• 9 Guzman R, Barth A, Lovblad K O et al.. Use of diffusion-weighted magnetic resonance imaging in differentiating purulent brain processes from cystic brain tumors.  J Neurosurg. 2002;  97 1101-1107
• 10 Leuthardt E C, Wippold II F J, Oswood M C, Rich K M. Diffusion-weighted MR imaging in the preoperative assessment of brain abscesses.  Surg Neurol. 2002;  58 395-402
• 11 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?.  J Neuroimaging. 2003;  13 330-338
• 12 Tung G A, Evangelista P, Rogg J M, Duncan III J A. Diffusion-weighted MR imaging of rim-enhancing brain masses: is markedly decreased water diffusion specific for brain abscess?.  AJR Am J Roentgenol. 2001;  177 709-712
• 13 Mishra A M, Gupta R K, Jaggi R S 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;  28 540-547
• 14 Garg M, Gupta R K, Husain M et al.. Brain abscesses: etiologic categorization with in vivo proton MR spectroscopy.  Radiology. 2003;  230 519-527
• 15 Maschke M, Dietrich U, Prumbaum M et al.. Opportunistic CNS infection after bone marrow transplantation.  Bone Marrow Transplant. 1999;  23 1167-1176
• 16 Dietrich U, Maschke M, Dorfler A, Prumbaum M, Forsting M. MRI of intracranial toxoplasmosis after bone marrow transplantation.  Neuroradiology. 2000;  42 14-18
• 17 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;  25 270-273
• 18 Chong-Han C H, Cortez S C, Tung G A. Diffusion-weighted MRI of cerebral toxoplasma abscess.  AJR Am J Roentgenol. 2003;  181 1711-1714
• 19 Skiest D J, Erdman W, Chang W E, Oz O K, Ware A, Fleckenstein J. SPECT thallium-210 combined with Toxoplasma serology for the presumptive diagnosis of focal central nervous system mass lesions in patients with AIDS.  J Infect. 2000;  40 274-281
• 20 Tali E T. Spinal infections.  Eur J Radiol. 2004;  50 120-133
• 21 Tur B S, Suldur N, Ataman S, Ozturk E A, Bingol A, Atay M B. Brucellar spondylitis: a rare cause of spinal cord compression.  Spinal Cord. 2004;  42 321-324
• 22 Jung N Y, Jee W H, Ha K Y, Park C K, Byun J Y. Discrimination of tuberculous spondylitis from pyogenic spondylitis by MRI.  AJR Am J Roentgenol. 2004;  182 1405-1410
• 23 Gupta S K, Chhabra R, Sharma B S, Das A, Khosla V K. Vertebral cryptococcosis simulating tuberculosis.  Br J Neurosurg. 2003;  17 556-559
• 24 Vaishya S, Sharma M S. Spinal Aspergillus vertebral osteomyelitis with extradural abscess: case report and review of the literature.  Surg Neurol. 2004;  61 551-555
• 25 Bluman E M, Palumbo M A, Lucas P R. Spinal epidural abscess in adults.  J Am Acad Orthop Surg. 2004;  12 155-163
• 26 van de Warrenburg B P, Wesseling P, Leyten Q H, Boerman R H. Myelopathy due to spinal epidural abscess without cord compression: a diagnostic pitfall.  Clin Neuropathol. 2004;  23 102-106
• 27 Tullman M J, Delman B N, Lublin F D, Weinberger J. Magnetic resonance imaging of meningoradiculomyelitis in early disseminated Lyme disease.  J Neuroimaging. 2003;  13 264-268
• 28 Srivastava T, Kochar D K. Asymptomatic spinal arachnoiditis in patients with tuberculous meningitis.  Neuroradiology. 2003;  45 727-729
• 29 Karacostas D, Christodoulou C, Drevelengas A et al.. Cytomegalovirus-associated transverse myelitis in a non-immunocompromised patient.  Spinal Cord. 2002;  40 145-149
• 30 Majid A, Galetta S L, Sweeney C J et al.. Epstein-Barr virus myeloradiculitis and encephalomyeloradiculitis.  Brain. 2002;  125 159-165
• 31 Minami K, Tsuda Y, Maeda H, Yanagawa T, Izumi G, Yoshikawa N. Acute transverse myelitis caused by Coxsackie virus B5 infection.  J Paediatr Child Health. 2004;  40 66-68
• 32 Jeha L E, Sila C A, Lederman R J, Prayson R A, Isada C M, Gordon S M. West Nile virus infection: a new acute paralytic illness.  Neurology. 2003;  61 55-59
• 33 Thurnher M M, Post M J, Jinkins J R. MRI of infections and neoplasms of the spine and spinal cord in 55 patients with AIDS.  Neuroradiology. 2000;  42 551-563
• 34 Oomman A, Madhusoodanan M. Tropical spastic paraparesis in Kerala.  Neurol India. 2003;  51 493-496
• 35 Schmutzhard E. Viral infections of the CNS with special emphasis on herpes simplex infections.  J Neurol. 2001;  248 469-477
• 36 Hinson V K, Tyor W R. Update on viral encephalitis.  Curr Opin Neurol. 2001;  14 369-374
• 37 Cinque P, Cleator G M, Weber T, Monteyne P, Sindic C J, van Loon A M. The role of laboratory investigation in the diagnosis and management of patients with suspected herpes simplex encephalitis: a consensus report.  J Neurol Neurosurg Psychiatry. 1996;  61 339-345
• 38 Marco de Lucas E, González Mandly A, Gutiérrez A et al.. Computed tomography perfusion usefulness in early imaging diagnosis of herpes simplex virus encephalitis.  Acta Radiol. 2006;  47 878-881
• 39 Maschke M, Kastrup O, Forsting M, Diener H C. Update on neuroimaging in infectious central nervous system disease.  Curr Opin Neurol. 2004;  17 475-480
• 40 Teixeira J, Zimmerman R A, Haselgrove J C, Bilaniuk L T, Hunter J V. Diffusion imaging in pediatric central nervous system infections.  Neuroradiology. 2001;  43 1031-1039
• 41 Kuker W, Nagele T, Schmidt F, Heckl S, Herrlinger U. Diffusion-weighted MRI in herpes simplex encephalitis: a report of three cases.  Neuroradiology. 2004;  46 122-125
• 42 Maschke M, Kastrup O, Diener H C. CNS manifestations of cytomegalovirus infections: diagnosis and treatment.  CNS Drugs. 2002;  16 303-315
• 43 Dyer J R, French M A, Mallal S A. Cerebral mass lesions due to cytomegalovirus in patients with AIDS: a report of two cases.  J Infect. 1995;  30 147-151
• 44 Moulignier A, Mikol J, Gonzalez-Canali G et al.. AIDS-associated cytomegalovirus infection mimicking central nervous system tumors: a diagnostic challenge.  Clin Infect Dis. 1996;  22 626-631
• 45 Chua K B, Goh K J, Wong K T et al.. Fatal encephalitis due to Nipah virus among pig-farmers in Malaysia.  Lancet. 1999;  354 1257-1259
• 46 Lim C C, Lee K E, Lee W L et al.. Nipah virus encephalitis: serial MR study of an emerging disease.  Radiology. 2002;  222 219-226
• 47 Lim C C, Lee W L, Leo Y S et al.. Late clinical and magnetic resonance imaging follow up of Nipah virus infection.  J Neurol Neurosurg Psychiatry. 2003;  74 131-133
• 48 Shen W C, Chiu H H, Chow K C, Tsai C H. MR imaging findings of enteroviral encephalomyelitis: an outbreak in Taiwan.  AJNR Am J Neuroradiol. 1999;  20 1889-1895
• 49 Nolan M A, Craig M E, Lahra M M et al.. Survival after pulmonary edema due to enterovirus 71 encephalitis.  Neurology. 2003;  60 1651-1656
• 50 Kalita J, Misra U K. Comparison of CT scan and MRI findings in the diagnosis of Japanese encephalitis.  J Neurol Sci. 2000;  174 3-8
• 51 Kalita J, Misra U K, Pandey S, Dhole T N. A comparison of clinical and radiological findings in adults and children with Japanese encephalitis.  Arch Neurol. 2003;  60 1760-1764
• 52 Sejvar J J, Haddad M B, Tierney B C et al.. Neurologic manifestations and outcome of West Nile virus infection.  JAMA. 2003;  290 511-515
• 53 Bosanko C M, Gilroy J, Wang A M et al.. West Nile virus encephalitis involving the substantia nigra: neuroimaging and pathologic findings with literature review.  Arch Neurol. 2003;  60 1448-1452
• 54 Einsiedel L, Kat E, Ravindran J, Slavotinek J, Gordon D L. MR findings in Murray Valley encephalitis.  AJNR Am J Neuroradiol. 2003;  24 1379-1382
• 55 Lee K Y, Cho W H, Kim S H, Kim H D, Kim I O. Acute encephalitis associated with measles: MRI features.  Neuroradiology. 2003;  45 100-106
• 56 Frings M, Blaeser I, Kastrup O. Adult-onset subacute sclerosing panencephalitis presenting as a degenerative dementia syndrome.  J Neurol. 2002;  249 942-943
• 57 Gagnon A, Bouchard R W. Fulminating adult-onset subacute sclerosing panencephalitis in a 49-year-old man.  Arch Neurol. 2003;  60 1160-1161
• 58 Alkan A, Sarac K, Kutlu R et al.. Early- and late-state subacute sclerosing panencephalitis: chemical shift imaging and single-voxel MR spectroscopy.  AJNR Am J Neuroradiol. 2003;  24 501-506
• 59 Astrom K E, Mancall E L, Richardson Jr E P. Progressive multifocal leukoencephalopathy: a hitherto unrecognized complication of chronic lymphocytic leukaemia and lymphoma.  Brain. 1958;  81 93-111
• 60 Berger J R, Pall L, Lanska D, Whiteman M. Progressive multifocal leukoencephalopathy in patients with HIV infection.  J Neurovirol. 1998;  4 59-68
• 61 Post M J, Yiannoutsos C, Simpson D 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 1896-1906
• 62 Kastrup O, Maschke M, Diener H C, Wanke I. Progressive multifocal leukoencephalopathy limited to the brain stem.  Neuroradiology. 2002;  44 227-230
• 63 Burgert S J, Classen D C, Burke J P, Blatter D D. Candidal brain abscess associated with vascular invasion: a devastating complication of vascular catheter-related candidemia.  Clin Infect Dis. 1995;  21 202-205
• 64 Narai H, Manabe Y, Deguchi K, Iwatsuki K, Sakai K, Abe K. Serial MRI findings in patients with chronic cryptococcus meningo-encephalitis.  Neurol Res. 2001;  23 810-812
• 65 Coley S C, Jäger H R, Szydlo R M, Goldman J M. CT and MRI manifestations of central nervous system infection following allogeneic bone marrow transplantation.  Clin Radiol. 1999;  54 390-397
• 66 Shuper A, Levitsky H I, Cornblath D R. Early invasive CNS aspergillosis. An easily missed diagnosis.  Neuroradiology. 1991;  33 183-185
• 67 Ashdown B C, Tien R D, Felsberg G J. Aspergillosis of the brain and paranasal sinuses in immunocompromised patients: CT and MR imaging findings.  AJR Roentgenol. 1994;  162 155-159
• 68 Dietrich U, Hettmann M, Maschke M, Dörfler A, Schwechheimer K, Forsting M. Cerebral aspergillosis: comparison of radiological and neuropathological findings in patients with bone marrow transplantation.  Eur Radiol. 2001;  11 1242-1249
• 69 Yuh W T, Nguyen H D, Gao F et al.. Brain parenchymal infection in bone marrow transplantation patients. CT and MR findings.  AJR Am J Roentgenol. 1994;  162 425-430