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Imaging in Neurologic Infections I: Bacterial and Parasitic Diseases

  • Central Nervous System Infections (J Lyons, Section Editor)
  • Published:
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Abstract

Often presenting as medical emergencies, nervous system infections can be diagnostically challenging. Knowledgeable utilization of neuroimaging modalities and the understanding of characteristic imaging findings facilitate early diagnosis and treatment. In the first part of this two-part review, we address common and unique diagnostic imaging features of bacterial and parasitic nervous system infections.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. WHO methods and data sources for global burden of disease estimates 2000–2011 [database on the Internet]. Department of Health Statistics and Information Systems WHO, Geneva 2013. Available from: http://www.who.int/healthinfo/statistics/GlobalDALYmethods.pdf?ua=1. Accessed 4 May 2014

  2. Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39(9):1267–84.

    Article  PubMed  Google Scholar 

  3. van Crevel H, Hijdra A, de Gans J. Lumbar puncture and the risk of herniation: when should we first perform CT? J Neurol. 2002;249(2):129–37.

    Article  PubMed  Google Scholar 

  4. Hasbun R, Abrahams J, Jekel J, Quagliarello VJ. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. N Engl J Med. 2001;345(24):1727–33. doi:10.1056/NEJMoa010399.

    Article  CAS  PubMed  Google Scholar 

  5. van de Beek D, de Gans J, Tunkel AR, Wijdicks EF. Community-acquired bacterial meningitis in adults. N Engl J Med. 2006;354(1):44–53.

    Article  PubMed  Google Scholar 

  6. Castillo M. Magnetic resonance imaging of meningitis and its complications. Top Magn Reson Imaging. 1994;6(1):53–8.

    CAS  PubMed  Google Scholar 

  7. Mohan S, Jain KK, Arabi M, Shah GV. Imaging of meningitis and ventriculitis. Neuroimaging Clin N Am. 2012;22(4):557–83. doi:10.1016/j.nic.2012.04.003. This review thoroughly summarizes pathophysiology of characteristic findings and advances in neuroimaging of various infectious causes of acute and chronic meningitis. It also illustrates differentiating imaging features of noninfectious causes of meningitis.

    Article  PubMed  Google Scholar 

  8. Weisfelt M, de Gans J, van der Poll T, van de Beek D. Pneumococcal meningitis in adults: new approaches to management and prevention. Lancet Neurol. 2006;5(4):332–42. doi:10.1016/S1474-4422(06)70409-4.

    Article  CAS  PubMed  Google Scholar 

  9. Brain Abscess. CONTINUUM: lifelong learning in neurology. 2002;8(3, Infectious Disease):38–47.

  10. Brouwer MC, Coutinho JM, van de Beek D. Clinical characteristics and outcome of brain abscess: systematic review and meta-analysis. Neurology. 2014;82(9):806–13. doi:10.1212/wnl.0000000000000172.

    Article  PubMed  Google Scholar 

  11. Fukui MB, Williams RL, Mudigonda S. CT and MR imaging features of pyogenic ventriculitis. AJNR Am J Neuroradiol. 2001;22(8):1510–6.

    CAS  PubMed  Google Scholar 

  12. Jorens PG, Voormolen MH, Robert D, Parizel PM. Imaging findings in pyogenic ventriculitis. Neurocrit Care. 2009;11(3):403–5. doi:10.1007/s12028-009-9263-3.

    Article  PubMed  Google Scholar 

  13. Ferreira NP, do Otta GM, Amaral LL, da Rocha AJ. Imaging aspects of pyogenic infections of the central nervous system. Top Magn Reson Imaging. 2005;16(2):145–54.

    Article  PubMed  Google Scholar 

  14. Beckham JD, Tyler KL. Neuro-intensive care of patients with acute CNS infections. Neurotherapeutics. 2012;9(1):124–38. doi:10.1007/s13311-011-0086-5.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Sarrazin JL, Bonneville F, Martin-Blondel G. Brain infections. Diagn Interv Imaging. 2012;93(6):473–90. doi:10.1016/j.diii.2012.04.020.

    Article  PubMed  Google Scholar 

  16. Stabler A, Reiser MF. Imaging of spinal infection. Radiol Clin North Am. 2001;39(1):115–35. doi:10.1016/S0033-8389%2805%2970266-9.

    Article  CAS  PubMed  Google Scholar 

  17. Love C, Palestro CJ. Radionuclide imaging of inflammation and infection in the acute care setting. Semin Nucl Med. 2013;43(2):102–13. doi:10.1053/j.semnuclmed.2012.11.003.

    Article  PubMed  Google Scholar 

  18. Go JL, Rothman S, Prosper A, Silbergleit R, Lerner A. Spine infections. Neuroimaging Clin N Am. 2012;22(4):755–72. doi:10.1016/j.nic.2012.06.002.

    Article  PubMed  Google Scholar 

  19. Wang VY, Chou D, Chin C. Spine and spinal cord emergencies: vascular and infectious causes. Neuroimaging Clin N Am. 2010;20(4):639–50. doi:10.1016/j.nic.2010.07.006.

    Article  PubMed  Google Scholar 

  20. Chin JH, Mateen FJ. Central nervous system tuberculosis: challenges and advances in diagnosis and treatment. Curr Infect Dis Rep. 2013. doi:10.1007/s11908-013-0385-6.

    PubMed  Google Scholar 

  21. Van TT, Farrar J. Tuberculous meningitis. J Epidemiol Community Health. 2014;68(3):195–6. doi:10.1136/jech-2013-202525.

    Article  PubMed  Google Scholar 

  22. Tuberculous Meningitis. CONTINUUM: lifelong learning in neurology. 2002;8(3, Infectious Disease):27–37.

  23. DeLance AR, Safaee M, Oh MC, Clark AJ, Kaur G, Sun MZ, et al. Tuberculoma of the central nervous system. J Clin Neurosci. 2013;20(10):1333–41. doi:10.1016/j.jocn.2013.01.008.

    Article  PubMed  Google Scholar 

  24. Patkar D, Narang J, Yanamandala R, Lawande M, Shah GV. Central nervous system tuberculosis: pathophysiology and imaging findings. Neuroimaging Clin N Am. 2012;22(4):677–705. doi:10.1016/j.nic.2012.05.006.

    Article  PubMed  Google Scholar 

  25. Lyons JL, Neagu MR, Norton IH, Klein JP. Diffusion tensor imaging in brainstem tuberculoma. J Clin Neurosci. 2013;20(11):1598–9. doi:10.1016/j.jocn.2013.01.003.

    Article  PubMed  Google Scholar 

  26. Zunt JR, Baldwin KJ. Chronic and subacute meningitis. Contin (Minneap Minn). 2012;18(6):1290–318. doi:10.1212/01.CON.0000423848.17276.21.

    Google Scholar 

  27. Ranganathan N, Hogarth K. Tuberculous meningitis. BMJ Case Rep. 2013;2013. doi:10.1136/bcr-2013-009412

  28. Thwaites G, Fisher M, Hemingway C, Scott G, Solomon T, Innes J. British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children. J Infect. 2009;59(3):167–87. doi:10.1016/j.jinf.2009.06.011.

    Article  PubMed  Google Scholar 

  29. Cho TA, Vaitkevicius H. Infectious myelopathies. Contin (Minneap Minn). 2012;18(6):1351–73. doi:10.1212/01.CON.0000423851.63017.2a.

    Google Scholar 

  30. Czarnowska-Cubala M, Wiglusz MS, Cubala WJ, Jakuszkowiak-Wojten K, Landowski J, Krysta K. MR findings in neurosyphilis—a literature review with a focus on a practical approach to neuroimaging. Psychiatr Danub. 2013;25 Suppl 2:S153–7.

    PubMed  Google Scholar 

  31. Marra CM. Update on neurosyphilis. Curr Infect Dis Rep. 2009;11(2):127–34.

    Article  PubMed  Google Scholar 

  32. Berger JR. Infectious myelopathies. Contin (Minneap Minn). 2011;17(4):761–75. doi:10.1212/01.CON.0000403794.13291.3d.

    Google Scholar 

  33. Tsui EY, Ng SH, Chow L, Lai KF, Fong D, Chan JH. Syphilitic myelitis with diffuse spinal cord abnormality on MR imaging. Eur Radiol. 2002;12(12):2973–6. doi:10.1007/s00330-001-1244-7.

    CAS  PubMed  Google Scholar 

  34. Halperin JJ. Lyme disease: a multisystem infection that affects the nervous system. Contin (Minneap Minn). 2012;18(6):1338–50. doi:10.1212/01.CON.0000423850.24900.3a.

    Google Scholar 

  35. Hildenbrand P, Craven DE, Jones R, Nemeskal P. Lyme neuroborreliosis: manifestations of a rapidly emerging zoonosis. AJNR Am J Neuroradiol. 2009;30(6):1079–87. doi:10.3174/ajnr.A1579.

    Article  CAS  PubMed  Google Scholar 

  36. Hattingen E, Weidauer S, Kieslich M, Boda V, Zanella FE. MR imaging in neuroborreliosis of the cervical spinal cord. Eur Radiol. 2004;14(11):2072–5. doi:10.1007/s00330-004-2300-x.

    Article  PubMed  Google Scholar 

  37. Rasalkar DD, Paunipagar BK, Sanghvi D, Sonawane BD, Loniker P. Magnetic resonance imaging in cerebral malaria: a report of four cases. Br J Radiol. 2011;84(1000):380–5. doi:10.1259/bjr/85759874.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  38. Roman GC. The neurology of parasitic diseases and malaria. Contin (Minneap Minn). 2011;17(1):113–33. doi:10.1212/01.CON.0000394678.13115.ad.

    Google Scholar 

  39. Sakai O, Barest GD. Diffusion-weighted imaging of cerebral malaria. J Neuroimaging. 2005;15(3):278–80.

    Article  PubMed  Google Scholar 

  40. Looareesuwan S, Laothamatas J, Brown TR, Brittenham GM. Cerebral malaria: a new way forward with magnetic resonance imaging (MRI). Am J Trop Med Hyg. 2009;81(4):545–7. doi:10.4269/ajtmh.2009.07-0411.

    Article  PubMed  Google Scholar 

  41. Del Brutto OH, Rajshekhar V, White Jr AC, Tsang VC, Nash TE, Takayanagui OM, et al. Proposed diagnostic criteria for neurocysticercosis. Neurology. 2001;57(2):177–83.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Chang KH, Han MH. MRI of CNS parasitic diseases. J Magn Reson Imaging. 1998;8(2):297–307.

    Article  CAS  PubMed  Google Scholar 

  43. Del Brutto OH. Neurocysticercosis. Contin (Minneap Minn). 2012;18(6):1392–416. doi:10.1212/01.CON.0000423853.47770.90.

    Google Scholar 

  44. Castillo M. Imaging of neurocysticercosis. Semin Roentgenol. 2004;39(4):465–73.

    Article  PubMed  Google Scholar 

  45. Abdel Razek AA, Watcharakorn A, Castillo M. Parasitic diseases of the central nervous system. Neuroimaging Clin N Am. 2011;21(4):815–41. doi:10.1016/j.nic.2011.07.005. This review describes imaging features of common parasitic intracranial and spinal infections along with their epidemiological, clinical and pathophysiological characteristics.

    Article  PubMed  Google Scholar 

  46. Rastogi S, Arora P, Devi P, Wazir SS, Kapoor S. Importance of ultrasonography and magnetic resonance imaging in diagnosis of cysticercosis of temporalis muscle mimicking temporal space infection. Contemp Clin Dent. 2013;4(4):504–8. doi:10.4103/0976-237X.123059.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Shoji H, Hirai T, Shirakura T, Takuma T, Okino T, Wakatsuki Y, et al. A case of cysticercosis with multiple lesions in the brain and femoral muscles. Kansenshogaku Zasshi. 2013;87(5):608–12.

    PubMed  Google Scholar 

  48. Schistosomiasis. World Health Organisation. 2014. http://www.who.int/schistosomiasis/en/. Accessed 4 May 2014.

  49. Ferrari TC, Moreira PR. Neuroschistosomiasis: clinical symptoms and pathogenesis. Lancet Neurol. 2011;10(9):853–64. doi:10.1016/S1474-4422(11)70170-3.

    Article  PubMed  Google Scholar 

  50. Akgoz A, Mukundan S, Lee TC. Imaging of rickettsial, spirochetal, and parasitic infections. Neuroimaging Clin N Am. 2012;22(4):633–57. doi:10.1016/j.nic.2012.05.015.

    Article  PubMed  Google Scholar 

  51. Turgut AT, Altin L, Topcu S, Kilicoglu B, Aliinok T, Kaptanoglu E, et al. Unusual imaging characteristics of complicated hydatid disease. Eur J Radiol. 2007;63(1):84–93.

    Article  PubMed  Google Scholar 

  52. Stojkovic M, Junghanss T. Cystic and alveolar echinococcosis. Handb Clin Neurol. 2013;114:327–34. doi:10.1016/B978-0-444-53490-3.00026-1.

    Article  PubMed  Google Scholar 

  53. Ghonge NP, Rajan S, Aggarwal B, Sahu AK. Imaging of ruptured endocyst in an isolated intramuscular hydatid cyst—the Scroll appearance. J Radiol Case Rep. 2012;6(8):17–21. doi:10.3941/jrcr.v6i8.739.

    PubMed Central  PubMed  Google Scholar 

  54. Carod-Artal FJ. American trypanosomiasis. Handb Clin Neurol. 2013;114:103–23. doi:10.1016/B978-0-444-53490-3.00007-8.

    Article  PubMed  Google Scholar 

  55. Di Lorenzo GA, Pagano MA, Taratuto AL, Garau ML, Meli FJ, Pomsztein MD. Chagasic granulomatous encephalitis in immunosuppressed patients computed tomography and magnetic resonance imaging findings. J Neuroimaging. 1996;6(2):94–7.

    PubMed  Google Scholar 

  56. Yoo TW, Mlikotic A, Cornford ME, Beck CK. Concurrent cerebral American trypanosomiasis and toxoplasmosis in a patient with AIDS. Clin Infect Dis. 2004;39(4):e30–4. doi:10.1086/422456.

    Article  PubMed  Google Scholar 

  57. Carod-Artal FJ, Vargas AP, Horan TA, Nunes LG. Chagasic cardiomyopathy is independently associated with ischemic stroke in Chagas disease. Stroke. 2005;36(5):965–70.

    Article  PubMed  Google Scholar 

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Conflict of Interest

Pooja Raibagkar and Martha Neagu have no conflicts of interest. Joshua Klein served as a board member for the American Society of Neuroimaging; received an Associate Editor stipend from the Journal of Neuroimaging; received honoraria from the American Academy of Neurology and honoraria from the Neurological Society of Pune, India; received payment for manuscript preparation from the AAN Continuum journal; and received royalties from the “Adams and Victor’s Principles of Neurology” textbook, 10th edition (McGraw-Hill). Jennifer Lyons received honoraria from Springer for working as a section editor.

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This article does not contain any studies with human or animal subjects performed by the authors.

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Authors and Affiliations

  1. Department of Neurology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Pooja Raibagkar, Martha R. Neagu, Jennifer L. Lyons & Joshua P. Klein

  2. Department of Radiology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Joshua P. Klein

  3. Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02115, USA

    Pooja Raibagkar & Martha R. Neagu

  4. Harvard Medical School, Boston, MA, 02115, USA

    Pooja Raibagkar, Martha R. Neagu, Jennifer L. Lyons & Joshua P. Klein

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  1. Pooja Raibagkar
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  2. Martha R. Neagu
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  4. Joshua P. Klein
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Correspondence to Joshua P. Klein.

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This article is part of the Topical Collection on Central Nervous System Infections

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Raibagkar, P., Neagu, M.R., Lyons, J.L. et al. Imaging in Neurologic Infections I: Bacterial and Parasitic Diseases. Curr Infect Dis Rep 16, 443 (2014). https://doi.org/10.1007/s11908-014-0443-8

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