Pyogenic Cerebritis and Brain Abscess
Despite essential proceedings in diagnosis and therapy during the past decades, pyogenic cerebritis and brain abscesses remain severe, potentially life-threatening diseases of the CNS that should be diagnosed without delay. The spectrum of pathogens differs considerably depending on the route of infection, on the one hand, and the status of the immune system of the host, on the other. In addition to the clinical examination, imaging studies are the main diagnostic clues for an early diagnosis. The different histological stages of abscess formation from early cerebritis to a mature encapsulated abscess are reflected in nonenhanced and contrast-enhanced CT and MR imaging findings. Magnetic resonance imaging is the imaging procedure of choice, not only in the primary diagnosis, but also in planning surgical or stereotactic procedures, and in the follow-up of patients with pyogenic brain infections. In addition to the morphological information, DWI, PerfMRI, and MRS add valuable metabolic information that may help to differentiate pyogenic infections from other disease processes. The main differential diagnoses of cerebritis include arterial or venous infarction, and nonpyogenic inflammations. Abscesses have to be discriminated from autochthonous and metastatic brain tumors.
KeywordsBrain Abscess Arterial Ischemic Stroke Venous Infarction Main Differential Diagnosis Necrotic Center
- Berlit P, Fedel C, Tornow K, Schmiedek P (1996) Bacterial brain abscess: experiences with 67 patients. Fortschr Neurol Psychiatr 64(8):297–306 [in German]Google Scholar
- Blanco García A, García Vázquez E, Benito N, Górgolas M de, Muñiz J, Gadea I, Ruiz Barnés P, Fernández Guerrero ML (1998) Brain abscess. Clinicomicrobiologic study and prognostic analysis of 59 cases. Rev Clin Esp 198(7):413–419 [in Spanish]Google Scholar
- Britt RH, Enzmann DR, Placone RC Jr, Obana WG, Yeager AS (1984) Experimental anaerobic brain abscess. Computerized tomographic and neuropathological correlations. J Neurosurg 60(6):1148–1159Google Scholar
- Maravilla KR, Maldjian JA, Schmalfuss IM, Kuhn MJ, Bowen BC, Wippold FJ 2nd, Runge VM, Knopp MV, Kremer S, Wolansky LJ, Anzalone N, Essig M, Gustafsson L (2006) Contrast enhancement of central nervous system lesions: multicenter intraindividual crossover comparative study of two MR contrast agents. Radiology 240(2):389–400PubMedCrossRefGoogle Scholar