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
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)
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
DDx: Neonatal Periventricular CalcificationDDx: Neonatal Periventricular Calcification
Congenital CMV
Toxoplasmosis LCM Pseudo-TORCHCMV
Microcephaly Ca++ 40-70%Gyral changesCerebellar hypoplasiaHydrocephalyHypodensitiesAbnormal WM
CMV
Congenital HIV
HIV
AtrophyBG Ca++Aneurysmal changes (vasculopathy)
DDx: Childhood Brain Ca++
CMVCMV Toxoplasmosis
Congenital HIV DDx
Congenital HerpesCongenital Herpes
Severe atrophyBG Ca++HemorrhageHydrocephalyMRS changes
CMV
DDx: TORCH
Toxoplasma+CMV Toxoplasmosis
Congenital herpes
Group B Streptococcal MeningitisHydrocephalyHypo dense artery territorial(stenosis)Hemoragic venus infarctSubdurl empyemaRim enhancement Abscess
DDx: Neonatal Meningoencephalitis
E.Coli
Citrobacter
HSV 2
Group B Streptococcal Meningitis
Group B Streptococcal Meningitis
Citrobacter Meningitis
DDx: DDx: Pediatric Cavitary White Matter Lessions
Pyogenic Abcess Encephalomalacia NAHI & WM Tears
Cerebritis Abscess squareLobar cavityMarginal, septal enhancement
Citrobacter Meningitis
Meningitis
DDx: Leptomeningeal Disease
Metastasis Neurosarcoidosis SAH MCA infarct
NormalHydrocephalyBasal cistern involvementArterial narrowingsExudate enhancementCerebral edema, infarct
Meningitis
Abscess
DDx: Ring-enhancing Lesions
Primary tumor
Resolving Clot
Demyelination
Metastasis
Early cerebritisLate cerebritisEarly cap.Late cap.CavityWall enhancement
Abscess
Ventriculitis
•Ventriculomegaly with debries•Enhanced ependyma
Empyema
DDx: Extra-axial Lesions
Chronic Hematoma Subdural Effusions Subdural Hygroma Dural Metastases
Extra-axial collectionBilateralRim enhancement
Herpes Encephalitis
Temporal Lobe Lesions
Status EpilepticusGliomatosis Cerebri
MCA IschemiaLimbic Encephalitis
NormalHypodensityBitemporal signals(Flair, T2)Patchy or Gyral enhancemnet or No
Herpes Encephalitis
Encephalitis (Miscellaneous)
DDx: Diffuse Parenchymal Lesions
ACA, MCA Ischemia Astrocytoma Herpes Encephalitis Status Epilepticus
NormalHigh signal T1High signal T2,Flair
Rasmussen Encephalitis
Sturge Weber Dyke Mason MELAS
Atrophy, hydrocephalyNo enhancementGyral swellingSignal change: edema
DDx: Cerebral Hemiatrophy
Tuberculosis
DDx: Intracranial TB (Meningeal, Parenchymal)
Bacterial Meningitis
NeurosarcoidosisPyogenic Abscess
Primary Glioma (GBM)
NormalBasal cistern thick enhancementTuberculomaCa++EnhancementSOL (rare)
Tuberculosis
Neurocysticercosis
DDx: Ring-enhancing Parenchymal Lesions
Tuberculoma
Pyogenic Abscess Metastases
Amebic Encephalitis
HydrocephalyRing enhancementsCyst and nidus insideCa++ granularGranular, vesicular patterns
Neurocysticercosis
Parasites, Miscellaneous
DDx: Ring-enhancing Parenchymal Lesions
Matastatic Disease
Cystic GBM Pyogenic Abscess
Neurocysticercosis
•Hydatid= simple cyst,no enhancement•Amebic=complex, cystic hypodensities
Parasites, Miscellaneous
Malaria Malaria
Paragonimiasis Paragonimiasis
Fugal Disease
DDx: Multiple Enhancing Brain Lesions in Immunosuppressed Patients
Cysticercosis MetastasesTB Septic Emboli
GranularLacunar, cysticEdemaHemorrhagehydrocephaly
Nocardiosis
Rickettsial Disease
DDx: Multifocal White Matter Lesions
M. Sclerosis
Vasculitis
Sarcoidosis
Herpes Simplex 1
Small WM lesionsMay enhancedBrain edemaCaudia equina enhancement
Lyme DiseaseLyme Disease
DDx: Common White Matter Hyperintensities
SarcoidosisMS Lacunar InfarctVasculitis
•UBO periventricular•Faint enhancement
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
HIV Encephalitis
Opportunistic Infection, AIDS
Focal Mass in HIV+
Primary Lymphoma Bacterial AbscessesToxo.
Hyperdense, Hypodense, Hyperintense related to:TB, PML, Toxo, Lymphoma
Opportunistic Infection, AIDS
CryptococcusPML: progressive multi
focal leukoencephalopathy TB
Multiple Sclerosis
ADEM Vasculitis Lyme Disease Susac Syndrome
Multiple Sclerosis
ADEM: Acute disseminated encephalomyelitis
DDx: Multifocal White Matter Lesions
MS Aging WM Lesions Fabry Disease Behcet
UBO`s with coalescence Centri petalSOL
ADEM
Subacute Sclerosing Panencephalitis
DDx: Confluent T2 Hyperintense White Matter Lesions
ADEM PML MS HIV
•Patchy signals•Brain edema
Thank you for your attentionThank you for your attention