brain (cns) infection imaging jalal jalal shokouhi – m.d. secretary of iranian society of...
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Brain (CNS) Infection ImagingBrain (CNS) Infection Imaging
Jalal Jalal Shokouhi – M.D.Jalal Jalal Shokouhi – M.D.Secretary of Iranian society of radiologySecretary of Iranian society of radiologyCooperation of Iranian radiologist, presidentCooperation of Iranian radiologist, president
[email protected] www.Medimage.ir
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Brain infection:1. Ever-growing,worldwide public health problem2. Age-old: TB, Malaria, more lethal due to
multidrug-resistant strains3. HIV is different face4. New diseases with no known vaccine (ebola,
biohazard level 4 agents)5. Wide spread immigrations6. World wide influenza (pandemic)
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Radiology 1.TORCH agents
Congenital CMV Congenital HIV Congenital herpes
2.Aquired infections Group B streptococcal meningitis Citrobacter meningitis Meningitis Abscess Ventriculitis Empyema Herpes encephalitis Encephalitis(miscellaneous) Rasmussen encephalitis TB
NeurocysticercosisParasitesFungalRickettsialLymeHIV encephalitisOpportunistic infection AIDS
3.Demyelinating diseases
MSADEMSubacute sclerosing panencephalitis
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DDx: Neonatal Periventricular CalcificationDDx: Neonatal Periventricular Calcification
Congenital CMV
Toxoplasmosis LCM Pseudo-TORCHCMV
Microcephaly Ca++ 40-70%Gyral changesCerebellar hypoplasiaHydrocephalyHypodensitiesAbnormal WM
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CMV
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Congenital HIV
HIV
AtrophyBG Ca++Aneurysmal changes (vasculopathy)
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DDx: Childhood Brain Ca++
CMVCMV Toxoplasmosis
Congenital HIV DDx
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Congenital HerpesCongenital Herpes
Severe atrophyBG Ca++HemorrhageHydrocephalyMRS changes
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CMV
DDx: TORCH
Toxoplasma+CMV Toxoplasmosis
Congenital herpes
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Group B Streptococcal MeningitisHydrocephalyHypo dense artery territorial(stenosis)Hemoragic venus infarctSubdurl empyemaRim enhancement Abscess
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DDx: Neonatal Meningoencephalitis
E.Coli
Citrobacter
HSV 2
Group B Streptococcal Meningitis
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Group B Streptococcal Meningitis
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Citrobacter Meningitis
DDx: DDx: Pediatric Cavitary White Matter Lessions
Pyogenic Abcess Encephalomalacia NAHI & WM Tears
Cerebritis Abscess squareLobar cavityMarginal, septal enhancement
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Citrobacter Meningitis
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Meningitis
DDx: Leptomeningeal Disease
Metastasis Neurosarcoidosis SAH MCA infarct
NormalHydrocephalyBasal cistern involvementArterial narrowingsExudate enhancementCerebral edema, infarct
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Meningitis
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Abscess
DDx: Ring-enhancing Lesions
Primary tumor
Resolving Clot
Demyelination
Metastasis
Early cerebritisLate cerebritisEarly cap.Late cap.CavityWall enhancement
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Abscess
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Ventriculitis
•Ventriculomegaly with debries•Enhanced ependyma
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Empyema
DDx: Extra-axial Lesions
Chronic Hematoma Subdural Effusions Subdural Hygroma Dural Metastases
Extra-axial collectionBilateralRim enhancement
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Herpes Encephalitis
Temporal Lobe Lesions
Status EpilepticusGliomatosis Cerebri
MCA IschemiaLimbic Encephalitis
NormalHypodensityBitemporal signals(Flair, T2)Patchy or Gyral enhancemnet or No
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Herpes Encephalitis
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Encephalitis (Miscellaneous)
DDx: Diffuse Parenchymal Lesions
ACA, MCA Ischemia Astrocytoma Herpes Encephalitis Status Epilepticus
NormalHigh signal T1High signal T2,Flair
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Rasmussen Encephalitis
Sturge Weber Dyke Mason MELAS
Atrophy, hydrocephalyNo enhancementGyral swellingSignal change: edema
DDx: Cerebral Hemiatrophy
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Tuberculosis
DDx: Intracranial TB (Meningeal, Parenchymal)
Bacterial Meningitis
NeurosarcoidosisPyogenic Abscess
Primary Glioma (GBM)
NormalBasal cistern thick enhancementTuberculomaCa++EnhancementSOL (rare)
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Tuberculosis
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Neurocysticercosis
DDx: Ring-enhancing Parenchymal Lesions
Tuberculoma
Pyogenic Abscess Metastases
Amebic Encephalitis
HydrocephalyRing enhancementsCyst and nidus insideCa++ granularGranular, vesicular patterns
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Neurocysticercosis
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Parasites, Miscellaneous
DDx: Ring-enhancing Parenchymal Lesions
Matastatic Disease
Cystic GBM Pyogenic Abscess
Neurocysticercosis
•Hydatid= simple cyst,no enhancement•Amebic=complex, cystic hypodensities
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Parasites, Miscellaneous
Malaria Malaria
Paragonimiasis Paragonimiasis
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Fugal Disease
DDx: Multiple Enhancing Brain Lesions in Immunosuppressed Patients
Cysticercosis MetastasesTB Septic Emboli
GranularLacunar, cysticEdemaHemorrhagehydrocephaly
Nocardiosis
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Rickettsial Disease
DDx: Multifocal White Matter Lesions
M. Sclerosis
Vasculitis
Sarcoidosis
Herpes Simplex 1
Small WM lesionsMay enhancedBrain edemaCaudia equina enhancement
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Lyme DiseaseLyme Disease
DDx: Common White Matter Hyperintensities
SarcoidosisMS Lacunar InfarctVasculitis
•UBO periventricular•Faint enhancement
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HIV Encephalitis
LymphomaPML HSV Encephalitis
DDx: Focal White Matter Abnormalities in HIV+
HHV6 Encephalitis
Children•Atrophy•WM disease•BG Ca++
Adult•Atrophy ,hydrocephaly•No enhancement
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HIV Encephalitis
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Opportunistic Infection, AIDS
Focal Mass in HIV+
Primary Lymphoma Bacterial AbscessesToxo.
Hyperdense, Hypodense, Hyperintense related to:TB, PML, Toxo, Lymphoma
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Opportunistic Infection, AIDS
CryptococcusPML: progressive multi
focal leukoencephalopathy TB
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Multiple Sclerosis
ADEM Vasculitis Lyme Disease Susac Syndrome
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Multiple Sclerosis
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ADEM: Acute disseminated encephalomyelitis
DDx: Multifocal White Matter Lesions
MS Aging WM Lesions Fabry Disease Behcet
UBO`s with coalescence Centri petalSOL
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ADEM
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Subacute Sclerosing Panencephalitis
DDx: Confluent T2 Hyperintense White Matter Lesions
ADEM PML MS HIV
•Patchy signals•Brain edema
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Thank you for your attentionThank you for your attention