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Infectious and inflammatory diseases of the central nervous system—the spectrum of imaging findings and differential diagnosis

Abstract

The infectious and inflammatory diseases of the central nervous system (CNS) including the brain and spine can present with a wide spectrum of clinical symptoms, locations, and appearance. The purpose of this exhibit is to review the different patterns of their presentations, to illustrate their imaging characteristics and techniques, and to discuss their clinical features and pathology so that the correct diagnosis can be made and prompt intervention can be initiated on a timely fashion.

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References

  1. 1.

    Charles G. Prober, Nivedita S. Srinivas, Roshni Mathew Nelson Textbook of Pediatrics. Chapter 603, 2936–2948.e2

  2. 2.

    Hazany S, Go JL, Law M (2004) Magnetic resonance imaging of infectious meningitis and ventriculitis in adults. Top Magn Reson Imaging 23(5):315–325

    Article  Google Scholar 

  3. 3.

    Mohan S, Jain KK, Arabi M, Shah GV (2012) Imaging of meningitis and ventriculitis. Neuroimaging Clin N Am 22(4):557–583. doi:10.1016/j.nic.2012.04.003 Epub 2012 Sep 4. Review

  4. 4.

    Chamberlain MC (2009) Leptomeningeal metastasis. Curr Opin Neurol Sep 4

  5. 5.

    Leal T, Chang JE, Mehta M, Robins HI (2011) Leptomeningeal metastasis: challenges in diagnosis and treatment. Curr Cancer Ther Rev 7(4):319–327

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Smirniotopoulos JM, Murphy FM, Rushing EJ, Rees JH, Shroeder JW (2007) Patterns of contrast enhancement in the brain and meninges. Radiographics 27:525–551

    Article  PubMed  Google Scholar 

  7. 7.

    Tosaka M, Sato N, Fujimaki H, Tanaka Y, Kagoshima K, Takahashi A et al (2008) Diffuse pachymeningeal hyperintensity and subdural effusion/hematoma detected by fluid-attenuated inversion recovery MR imaging in patients with spontaneous intracranial hypotension. Am J Neuroradiol 29:1164–1170

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Osborn AG, Blaser S, Salzman KL (2004) Diagnostic imaging: brain. 1st ed. Salt Lake City: Amirsys. Intracranial hypotension; p. II-4–22 10

  9. 9.

    Theil D, Arbusow V, Derfuss T, Strupp M, Pfeiffer M, Mascolo A, Brandt T (2001) Prevalence of HSV-1 LAT in human trigeminal, geniculate, and vestibular ganglia and its implication for cranial nerve syndromes. Brain Pathol 11:408–413

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Chow FC, Glaser CA, Sheriff H, Xia D, Messenger S, Whitley R et al (2015) Use of clinical and neuroimaging characteristics to distinguish temporal lobe herpes simplex encephalitis from its mimics. Clin Infect Dis 60(9):1377–1383

    PubMed  PubMed Central  Google Scholar 

  11. 11.

    Tüzün E, Dalmau J (2007) Limbic encephalitis and variants: classification, diagnosis and treatment. Neurologist 13(5)

  12. 12.

    Horst U (2006) Serial MRI of limbic encephalitis. Neuroradiology 48(6):380–386

    Article  Google Scholar 

  13. 13.

    Louis DN, Ohgaki H, Wiestler OD, Cavenee WK WHO classification of tumours of the central nervous system. 4th Edition Revised

  14. 14.

    Haimes AB, Zimmerman RD, Morgello S et al (1989) MR imaging of brain abscesses. Am J Roentgenol 152(5):1073–1085

    CAS  Article  Google Scholar 

  15. 15.

    Cartes-Zumelzu FW, Stavrou I, Castillo M, Eisenhuber E, Knosp E, Thurnher MM (2004) Diffusion-weighted imaging in the assessment of brain abscesses therapy. Am J Neuroradiol 25(8):1310–1317

    PubMed  Google Scholar 

  16. 16.

    Brant WE, Helms CA (2007) Fundamentals of diagnostic radiology. Lippincott Williams & Wilkins

  17. 17.

    Allen LM, Hasso AN, Handwerker J et al (2012) Sequence-specific MR imaging findings that are useful in dating ischemic stroke. Radiographics 32(5):1285–1297

    Article  PubMed  Google Scholar 

  18. 18.

    Karonen JO, Partanen PL, Vanninen RL et al (2001) Evolution of MR contrast enhancement patterns during the first week after acute ischemic stroke. Am J Neuroradiol 22(1):103–111

    CAS  PubMed  Google Scholar 

  19. 19.

    Mattogno PP, Signorelli F, Visocchi M (2017) Intracranial subdural empyema: diagnosis and treatment update. J Neurosurg Sci

  20. 20.

    Rich PM, Deasy NP, Jarosz JM (2000) Intracranial Dural Empyema. Br J Radiol 73(876):1329–1336

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Farrell CJ, Hoh BL, Pisculli ML, Henson JW, Barker FG 2nd, Curry WT Jr (2008) Limitations of diffusion-weighted imaging in the diagnosis of postoperative infections. Neurosurgery 62(3):577–583 discussion −83

    Article  PubMed  Google Scholar 

  22. 22.

    Tsuchiya K, Osawa A, Katase S, Fujikawa A, Hachiya J, Aoki S (2003) Diffusion-weighted MRI of subdural and epidural empyemas. Neuroradiology 45(4):220–223

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Graham DI, Gennareli TA (2000) Chapter 5, Pathology of brain damage after head injury. In: Cooper P, Golfinos G (eds) Head injury, 4th edn. Morgan Hill, New York

    Google Scholar 

  24. 24.

    Smith MH, Dormont RE, Prather GW (1951) Subdural effusions complicating bacterial meningitis. Pediatrics Vol 7 Issue 1

  25. 25.

    Smith AB, Smirniotopoulos JG, Rushing EJ (2008) Central nervous system infections associated with human immunodeficiency virus infection: radiologic-pathologic correlation. RadioGraphics 28:2033–2058

    Article  PubMed  Google Scholar 

  26. 26.

    Lee GT, Antelo F, Mlikotic AA (2009) Cerebral toxoplasmosis. RadioGraphics 29:1200–1205

    Article  PubMed  Google Scholar 

  27. 27.

    Chong-Han CH, Cortez SC, Tung GA (2003) Diffusion-weighted MRI of cerebral toxoplasmosis abscess. Am J Roentgenol 181:1711–1714

    Article  Google Scholar 

  28. 28.

    Garg RK, Sinha MK (2010) Multiple ring-enhancing lesions of the brain. J Postgrad Med 56:307–316

    CAS  Article  PubMed  Google Scholar 

  29. 29.

    Godi C, De Vita E, Tombetti E, Davagnanam I, Haddow L, Jager HR (2017) High B-value diffusion-weighted imaging in progressive multifocal leukoencephalopathy in HIV patients. European Radiology

  30. 30.

    Schweitzer AD, Parikh NS, Askin G, et al (2017) Imaging characteristics associated with clinical outcomes in posterior reversible encephalopathy syndrome. Neuroradiology

  31. 31.

    Raman R, Devaramane R, Jagadish GM, Chowdaiah S (2017) Various imaging manifestations of posterior reversible encephalopathy syndrome on magnetic resonance imaging. Pol J Radiol 82:64–70

    Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Sarbu N, Shih RY, Jones RV et al (2016) White matter diseases with radiologic-pathologic correlation. Radiographics 36(5):1426–1447

    Article  PubMed  Google Scholar 

  33. 33.

    Dutra LA, de Souza AW, Grinberg-Dias G, Barsottini OG, Appenzeller S (2007) Central nervous system vasculitis in adults: an update. Autoimmun Rev 16(2):123–131. doi:10.1016/j.autrev.2016.12.001 Epub 2017 Jan 11

    Article  Google Scholar 

  34. 34.

    Zuccoli G, Pipitone N, Haldipur A, Brown RD Jr, Hunder G, Salvarani C (2011) Imaging findings in primary central nervous system vasculitis. Clin Exp Rheumatol 29(1 Suppl 64):S104–S109 Epub 2011 May 11

    PubMed  Google Scholar 

  35. 35.

    Hajj-Ali RA (2010) Primary angiitis of the central nervous system: differential diagnosis and treatment. Best Pract Res Clin Rheumatol 24(3):413–426. doi:10.1016/j.berh.2009.12.003

    Article  PubMed  Google Scholar 

  36. 36.

    van den Wijngaard IR, Holswilder G, van Walderveen MA, Algra A, Wermer MJ, Zaidat OO, Boiten J (2016) Treatment and imaging of intracranial atherosclerotic stenosis: current perspectives and future directions. Brain Behav 6(11):e00536 eCollection 2016

    Article  PubMed  PubMed Central  Google Scholar 

  37. 37.

    Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ et al (2015) A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 372(1):11–20

    Article  PubMed  Google Scholar 

  38. 38.

    Hammad TA, Hajj-Ali RA (2013) Primary angiitis of the central nervous system and reversible cerebral vasoconstriction syndrome. Curr Atheroscler Rep 15(8):346. doi:10.1007/s11883-013-0346-4

    Article  PubMed  Google Scholar 

  39. 39.

    Numaguchi Y, Rigamonti D, Rothman MI et al (1993) Spinal epidural abscess: evaluation with gadolinium-enhanced MR imaging. Radiographics 13(3):545–559

    CAS  Article  PubMed  Google Scholar 

  40. 40.

    Holtås S, Heiling M, Lönntoft (1996) Spontaneous spinal epidural hematoma: findings at MR imaging and clinical correlation. Radiology 199:409–413

    Article  PubMed  Google Scholar 

  41. 41.

    Kim RY, Spencer SA, Meredith RF et al (1990) Extradural spinal cord compression: analysis of factors determining functional prognosis—prospective study. Radiology 176(1):279–282

    CAS  Article  PubMed  Google Scholar 

  42. 42.

    Schiff D, O’Neill BP, Wang CH, O’Fallon JR Neuroimaging and treatment implications of patients with multiple epidural spinal metastases. Cancer 83(8):1593–1601 m 1998

  43. 43.

    Atlas SW (2009) Magnetic resonance imaging of the brain and spine. Lippincott Williams & Wilkins

  44. 44.

    Lennon VA, Wingerchuk DM, Kryzer TJ et al (2004) A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis. Lancet 364(9451):2106–2112

    CAS  Article  PubMed  Google Scholar 

  45. 45.

    Wingerchuk DM, Lennon VA, Pittock SJ, Lucchinetti CF, Weinshenker BG (2006) Revised diagnostic criteria for neuromyelitis optica. Neurology 66(10):1485–1489

    CAS  Article  PubMed  Google Scholar 

  46. 46.

    Jasiak-Zatonska M, Kalinowska-Lyszczarz A, Michalak S, Kozubski W (2016) The immunology of neuromyelitis optica—current knowledge, clinical implications, controversies and future perspectives. Int J Mol Sci 17(3):273

    Article  PubMed  PubMed Central  Google Scholar 

  47. 47.

    Scotti G, Gerevini S (2001) Diagnosis and differential diagnosis of acute transverse myelopathy. The role of neuroradiological investigations and review of the literature. Neurol Sci 22(Suppl 2):S69–S73

    Article  PubMed  Google Scholar 

  48. 48.

    Gorson KC, Ropper AH, Muriello MA, Blair R (1996) Prospective evaluation of MRI lumbosacral nerve root enhancement in acute Guillain-Barré syndrome. Neurology 47(3):813–817

    CAS  Article  PubMed  Google Scholar 

  49. 49.

    Fulbright RK, Erdum E, Sze G et al (1995) Cranial nerve enhancement in the Guillain-Barré syndrome. Am J Neuroradiol 16(4):923–925

    CAS  PubMed  Google Scholar 

  50. 50.

    Berciano J (2011) Thickening and contrast enhancement of spinal roots on MR imaging in Guillain-Barré syndrome: thoughts on pathologic background. Am J Neuroradiol 32:E179. doi:10.3174/ajnr.A2754

    CAS  Article  PubMed  Google Scholar 

  51. 51.

    Byun WM, Park WK, Park BH, Ahn SH, Hwang MS, Chang JC (1998) Guillain-Barré syndrome: MR imaging findings of the spine in eight patients. Radiol 208(1):137–141

    CAS  Article  Google Scholar 

  52. 52.

    Georgy BA, Snow RD, Hesselink JR (1996) MR imaging of spinal nerve roots: techniques, enhancement patterns, and imaging findings. Am J Radiol 166:173–179

    CAS  Google Scholar 

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Correspondence to Shan Li.

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Rozell, J.M., Mtui, E., Pan, YN. et al. Infectious and inflammatory diseases of the central nervous system—the spectrum of imaging findings and differential diagnosis. Emerg Radiol 24, 619–633 (2017). https://doi.org/10.1007/s10140-017-1543-1

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Keywords

  • Infectious diseases
  • Inflammatory diseases
  • CNS
  • Brain and spine