Cerebral Infections

  • David J. Mikulis
  • Majda M. ThurnherEmail author


The broad categories of infectious diseases that affect the central nervous system (CNS) continue to present diagnostic challenges. Although imaging patterns of disease are well established, overlap between categories can occur. For example, the differentiation of cysticercosis, a parasitic infection from a tuberculous abscess, a bacterial infection, can be difficult. Additional challenges are posed by the increasing probability of encountering non-endemic pathogens secondary to the “globalization” of infections brought on by the expansion of international travel, transportation, and immigration. Additionally, increasing numbers of patients are undergoing treatments and therapies that compromise the immune system, leading to altered host responses that no longer express the expected patterns of tissue injury.


Infection Viral Parasitic Bacterial Fungal Abscess Meningitis Encephalitis Empyema 


  1. 1.
    Thigpen MC, Whitney CG, Messonnier NE et al (2011) Bacterial meningitis in the United States, 1998–2007. N Engl J Med 364(21):2016–2025CrossRefPubMedGoogle Scholar
  2. 2.
  3. 3.
  4. 4.
    Chatterjee T, Gowardman JR, Goh TD (2003) Pneumococcal meningitis masquerading as subarachnoid hemorrhage. Med J Aust 178(10):505–507PubMedGoogle Scholar
  5. 5.
    Mitchell P, Wilkinson I, Hoggard N et al (2001) Detection of subarachnoid haemorrhage with magnetic resonance imaging. J Neurol Neurosurg Psychiatry 70(2):205–211CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Tung GA, Rogg JM (2003) Diffusion-weighted imaging of cerebritis. AJNR 24(6):1110–1113PubMedGoogle Scholar
  7. 7.
    Karanja BW, Oburra HO, Masinde P, Wamalwa D (2014) Prevalence of hearing loss in children following bacterial meningitis in a tertiary referral hospital. BMC Res Notes 7:138CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Kopelovich JC, Germiller JA, Laury AM, Shah SS, Pollock AN (2011) Early prediction of post-meningitic hearing loss in children using magnetic resonance imaging. Arch Otolaryngol Head Neck Surg 137(5):441–447CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Kuwahara S, Kawada M, Uga S (2001) Cryptococcal meningoencephalitis presenting with an unusual MRI appearance–case report. Neurol Med Chir (Tokyo) 41(10):517–521CrossRefGoogle Scholar
  10. 10.
    Goyal M, Sharma A, Mishra NK, Gaikwad SB, Sharma MC (1997) Imaging appearance of pachymeningeal tuberculosis. AJR 169(5):1421–1424CrossRefPubMedGoogle Scholar
  11. 11.
    Erly WK, Bellon RJ, Seeger JF, Carmody RF (1999) MR imaging of acute coccidioidal meningitis. AJNR 20(3):509–514PubMedGoogle Scholar
  12. 12.
    Berkefeld J, Enzensberger W, Lanfermann H (1999) Cryptococcus meningoencephalitis in AIDS: parenchymal and meningeal forms. Neuroradiology 41(2):129–133CrossRefPubMedGoogle Scholar
  13. 13.
    Britt RH, Enzmann DR (1983) Clinical stages of human brain abscesses on serial CT scans after contrast infusion. Computerized tomographic, neuropathological, and clinical correlations. J Neurosurg 59(6):972–989CrossRefPubMedGoogle Scholar
  14. 14.
    Haimes AB, Zimmerman RD, Morgello S, Weingarten K, Becker RD, Jennis R, Deck MD (1989) MRI of brain abscesses. AJR 152(5):1073–1085CrossRefPubMedGoogle Scholar
  15. 15.
    Muccio CF, Caranci F, D’Arco F, Cerase A, De Lipsis L, Esposito G, Tedeschi E, Andreula C (2014) Magnetic resonance features of pyogenic brain abscesses and differential diagnosis using morphological and functional imaging studies: a pictorial essay. J Neuroradiol 41(3):153–167CrossRefPubMedGoogle Scholar
  16. 16.
    Mishra AM, Gupta RK, Saksena S, Prasad KN, Pandey CM, Rathore D, Purwar A, Rathore RK, Husain N, Jha DK, Jaggi RS, Husain M (2005) Biological correlates of diffusivity in brain abscess. Magn Reson Med 54(4):878–885CrossRefPubMedGoogle Scholar
  17. 17.
    Tomar V, Yadav A, Rathore RK, Verma S, Awasthi R, Bharadwaj V, Ojha BK, Prasad KN, Gupta RK (2011) Apparent diffusion coefficient with higher b- value correlates better with viable cell count quantified from the cavity of brain abscess. AJNR Am J Neuroradiol 32(11):2120–2125CrossRefPubMedGoogle Scholar
  18. 18.
    Gupta RK, Nath K, Prasad A et al (2008) In vivo demonstration of neuroinflammatory molecule expression in brain abscess with diffusion tensor imaging. AJNR Am J Neuroradiol 29:326–332CrossRefPubMedGoogle Scholar
  19. 19.
    Nath K, Ramola M, Husain M et al (2010) Assessment of therapeutic response in patients with brain abscess using diffusion tensor imaging. World Neurosurg 73:63–68CrossRefPubMedGoogle Scholar
  20. 20.
    Toh CH, Wei KC, Chang CH et al (2012) Differentiation of pyogenic brain abscesses from necrotic glioblastoma with use of susceptibility-weighted imaging. AJNR 33(8):1534–1538CrossRefPubMedGoogle Scholar
  21. 21.
    Lai PH, Li KT, Hsu SS et al (2005) Pyogenic brain abscess: findings from in vivo 1.5-T and 11.7-T in vitro proton MR spectroscopy. AJNR Am J Neuroradiol 26:279–288PubMedGoogle Scholar
  22. 22.
    Dev R, Gupta RK, Poptani H, Roy R, Sharma S, Husain M (1998) Role of in vivo proton magnetic resonance spectroscopy in the diagnosis and management of brain abscesses. Neurosurgery 42(1):37–43CrossRefPubMedGoogle Scholar
  23. 23.
    Dusak A, Hakyemez B, Kocaeli H, Bekar A (2012) Magnetic resonance spectroscopy findings of pyogenic, tuberculous, and cryptococcus intracranial abscesses. Neurochem Res 37(2):233–237CrossRefPubMedGoogle Scholar
  24. 24.
    Gupta RK, Prakash M, Mishra AM et al (2005) Role of diffusion weighted imaging in differentiation of intracranial tuberculoma and tuberculous abscess from cysticercus granulomas – a report of more than 100 lesions. Eur J Radiol 55(3):384–392CrossRefPubMedGoogle Scholar
  25. 25.
    Gupta RK, Vatsal DK, Husain N, Chawla S, Prasad KN, Roy R, Kumar R, Jha D, Husain M (2001) Differentiation of tuberculous from pyogenic brain abscesses with in vivo proton MRS and magnetization transfer MRI. AJNR 22(8):1503–1509PubMedGoogle Scholar
  26. 26.
    Liu TB, Perlin DS, Xue C (2012) Molecular mechanisms of cryptococcal meningitis. Virulence 3(2):173–181CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Smith AB, Smirniotopoulos JG, Rushing EJ (2008) From the archives of the AFIP: CNS infections associated with HIV infection: radiologic-pathologic correlation. Radiographics 28(7):2033–2058CrossRefPubMedGoogle Scholar
  28. 28.
    Katchanov J, Branding G, Jefferys L, Arastéh K, Stocker H, Siebert E (2016) Neuroimaging of HIV-associated cryptococcal meningitis: comparison of magnetic resonance imaging findings in patients with and without immune reconstitution. Int J STD AIDS 27(2):110–117CrossRefPubMedGoogle Scholar
  29. 29.
    Siegal JA, Cacayorinb ED, Nassif AS, Rizk D, Galambos C, Levy B, Kennedy D, Visconti J, Perman W (2000) Cerebral mucormycosis: proton MR spectroscopy and MR imaging. Magn Reson Imaging 18(7):915–920CrossRefPubMedGoogle Scholar
  30. 30.
    Andrade AI, Donato M, Previgliano C, Hardjasudarma M (2014) Histoplasmosis brain abscesses in an immunocompetent adult. A case report and literature review. Neuroradiol J 27(3):334–338PubMedGoogle Scholar
  31. 31.
    Yamada K, Zoarski GH, Rothman MI, Zagardo MT, Nishimura T, Sun CC (2001) An intracranial aspergilloma with low signal on T2-weighted images corresponding to iron accumulation. Neuroradiology 43(7):559–561CrossRefPubMedGoogle Scholar
  32. 32.
    Luthra G, Parihar A, Nath K, Jaiswal S, Prasad KN, Husain N, Husain M, Singh S, Behari S, Gupta RK (2007) Comparative evaluation of fungal, tubercular, and pyogenic brain abscesses with conventional and diffusion MR imaging and proton MR spectroscopy. AJNR Am J Neuroradiol 28(7):1332–1338CrossRefPubMedGoogle Scholar
  33. 33.
    Lee WK, Mossop PJ, Little AF, Fitt GJ, Vrazas JI, Hoang JK et al (2008) Infected (mycotic) aneurysms: spectrum of imaging appearances and management. Radiographics 28(7):1853–1868CrossRefPubMedGoogle Scholar
  34. 34.
    Allen LM, Fowler AM, Walker C, Derdeyn CP, Nguyen BV, Hasso AN et al (2013) Retrospective review of cerebral mycotic aneurysms in 26 patients: focus on treatment in strongly immunocompromised patients with a brief literature review. AJNR 34(4):823–827CrossRefPubMedGoogle Scholar
  35. 35.
    Norlinah MI, Ngow HA, Hamidon BB (2007) Angioinvasive cerebral aspergillosis presenting as acute ischaemic stroke in a patient with diabetes mellitus. Singapore Med J 48(1):e1–e4PubMedGoogle Scholar
  36. 36.
    Palacios E, Rojas R, Rodulfa J, González-Toledo E (2014) Magnetic resonance imaging in fungal infections of the brain. Top Magn Reson Imaging 23(3):199–212CrossRefPubMedGoogle Scholar
  37. 37.
    Kleihues P, Lang W, Burger PC et al (1985) Progressive diffuse leukoencephalopathy in patients with acquired immune deficiency syndrome (AIDS). Acta Neuropathol (Berl) 68:333–339CrossRefGoogle Scholar
  38. 38.
    Olsen WL, Longo FM, Mills CM et al (1988) White matter disease in AIDS: findings at MR imaging. Radiology 169:445–448CrossRefPubMedGoogle Scholar
  39. 39.
    Filippi CG, Sze G, Farber SJ et al (1998) Regression of HIV encephalopathy and basal ganglia signal intensity abnormality at MR imaging in patients with AIDS after initiation of protease inhibitor therapy. Radiology 206:491–498CrossRefPubMedGoogle Scholar
  40. 40.
    Thurnher MM, Schindler EG, Thurnher SA et al (2000) Highly active antiretroviral therapy for patients with AIDS dementia complex: effect on MR imaging findings and clinical course. AJNR Am J Neuroradiol 21:670–678PubMedGoogle Scholar
  41. 41.
    Padget BL, Walker DL, ZuRhein GM et al (1997) Cultivation of papova-like virus from human brain with progressive multifocal leukoencephalopathy. Neuroradiology 1997;39(9):611–618.Google Scholar
  42. 42.
    Thurnher MM, Thurnher SA, Mühlbauer B et al (1997) Progressive multifocal leukoencephalopathy in AIDS: initial and follow-up CT and MRI. Neuroradiology 39(9):611–618Google Scholar
  43. 43.
    Shapiro RA, Mullane KM, Camras L et al (2001) Clinical and magnetic resonance imaging regression of progressive multifocal leukoencephalopathy in an AIDS patient after intensive antiretroviral therapy. J Neuroimaging 11:336–339CrossRefPubMedGoogle Scholar
  44. 44.
    Thurnher MM, Donovan Post MJ, Rieger A et al (2001) Initial and follow-up MR imaging findings in AIDS-related progressive multifocal leukoencephalopathy treated with highly active antiretroviral therapy. AJNR Am J Neuroradiol 22:977–984PubMedGoogle Scholar
  45. 45.
    Post MJ, Thurnher MM, Clifford DB, Nath A, Gonzalez RG, Gupta RK, Post KK (2013) CNS-immune reconstitution inflammatory syndrome in the setting of HIV infection, part 2: discussion of neuro-immune reconstitution inflammatory syndrome with and without other pathogens. AJNR Am J Neuroradiol 34(7):1308–1318CrossRefPubMedGoogle Scholar
  46. 46.
    Post MJ, Thurnher MM, Clifford DB, Nath A, Gonzalez RG, Gupta RK, Post KK (2013) CNS-immune reconstitution inflammatory syndrome in the setting of HIV infection, part 1: overview and discussion of progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome and cryptococcal-immune reconstitution inflammatory syndrome. AJNR Am J Neuroradiol 34(7):1297–1307CrossRefPubMedGoogle Scholar
  47. 47.
    Wattjes MP, Warnke C (2016) Guidelines on PML risk stratification and diagnosis in patients with MS treated with natalizumab: so far so good? J Neurol Neurosurg Psychiatry 87(2):115PubMedGoogle Scholar
  48. 48.
    Sinnecker T, Othman J, Kühl M, Mekle R, Selbig I, Niendorf T, Kunkel A, Wienecke P, Kern P, Paul F, Faiss J, Wuerfel J (2015) 7T MRI in natalizumab-associated PML and ongoing MS disease activity: a case study. Neurol Neuroimmunol Neuroinflamm 2(6):e171CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Küker W, Nägele T, Schmidt F et al (2004) Diffusion-weighted MRI in herpes simplex encephalitis: a report of three cases. Neuroradiology 46:122–125CrossRefPubMedGoogle Scholar
  50. 50.
    Renard D, Nerrant E, Lechiche C (2015) DWI and FLAIR imaging in herpes simplex encephalitis: a comparative and topographical analysis. J Neurol 262(9):2101–2105CrossRefPubMedGoogle Scholar
  51. 51.
    Kaewpoowat Q, Salazar L, Aguilera E, Wootton SH, Hasbun R. Herpes simplex and varicella zoster CNS infections: clinical presentations, treatments and outcomes. Infection 2015 Dec 17 [Epub ahead of print].Google Scholar
  52. 52.
    Kumar GG, Mahadevan A, Guruprasad AS, Kovoor JM, Satishchandra P, Nath A, Ranga U, Shankar SK (2010) Eccentric target sign in cerebral toxoplasmosis: neuropathological correlate to the imaging feature. J Magn Reson Imaging 31(6):1469–1472CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Villringer K, Jager H, Dichgans M et al (1995) Differential diagnosis of CNS lesions in AIDS patients by FDG-PET. J Comput Assist Tomogr 19:532–536CrossRefPubMedGoogle Scholar
  54. 54.
    Mueller-Mang C, Castillo M, Mang TG, Cartes-Zumelzu F, Weber M, Thurnher MM (2007) Fungal versus bacterial brain abscesses: is diffusion-weighted MR imaging a useful tool in the differential diagnosis? Neuroradiology 49:651–657CrossRefPubMedGoogle Scholar
  55. 55.
    Finelli PF, Wrubel GL (2015) Bilateral pallidal hemorrhage in toxoplasmosis update of acute symmetric lesions of deep nuclei. Neuroradiol J 28(4):413–417CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department Medical ImagingThe University Health Network, The Toronto Western Hospital, The University of TorontoTorontoCanada
  2. 2.Department of Biomedical Imaging and Image-Guided TherapyUniversity Hospital Vienna, Medical University ViennaViennaAustria

Personalised recommendations