brain infections 1

Infections of the Brain and

Meninges

Mohamed SamirAssisst. Lecturer

Infections

Congenital / Neonatal Acquired

• Cytomegalovirus.• Toxoplasmosis.

• Rubella.

• Herpes Simplex.

• HIV Infection.• Enteroviruses.

• Meningitis.• Pyogenic

Parenchymal Infections.

• Encephalitis.

• TB & Fungal Infections.

• Parasitic Infections.

Congenital/Neonatal Infections

Congenital/Neonatal InfectionsCongenital/Neonatal Infections

• Agent:

TORCH

Toxoplasmosis.

Rubella.

Cytomegalovirus.

Herpes Simplex.

HIVSyphilis


Route of Infection:

• Transplacental.• Through birth canal.• Ascending cervical.


Effects:

• Malformations.

• Brain Destruction.

• Dystrophic calcifications.

Cytomegalovirus

I. Congenital/Neonatal Infections

Pathology:

- Affinity for the developing germinal matrix.

- Widespread periventricular necrosis and subsequent dystrophic calcifications.

- May cause abnormal neuronal migration.

Cytomegalovirus


I. Plain X-Ray:

Microcephaly + Eggshell-like periventricular calcifications.

Cytomegalovirus


Bilateral periventricular

calcifications.

Widespread cerebral destruction

and encephalomalasia.

II. US:

Cytomegalovirus


II. US:

Cytomegalovirus


Atrophy & Ventricular

Enlargement.

Periventricular Calcifications.

Neuronal Migration Anomalies.

III. CT:

Cytomegalovirus


As in CT +

Neuronal Migrational Anomalies.

Delayed Myelination.

Subependymal Paraventricular

Cysts & Calcifications.

IV. MRI:

Cytomegalovirus


IV. MRI:

Cytomegalovirus


Associated features:

Hepatosplenomegaly.

Jaundice.

Chorioretinitis.

WHY MEN DIE BEFORE WOMEN!


Toxoplasmosis

Pathology:

Triad of: Hydrocephalus, Calcifications and Chorioretinitis.

Multifocal and scattered.

Necrosis & Calcification

No migration anomalies.


Toxoplasmosis

I. Plain X-Ray:


Toxoplasmosis

II. US:


Toxoplasmosis

- Hydrocephalus.

- Multiple, irregular, nodular, cyst-like

or curvilinear calcifications in the

periventricular areas and the choroid

plexus.

III. CT:


Rubella

• Pathology:

- Inhibits cell proliferation and myelination.

- Prominent ocular abnormalities.

- Calcifications in basal ganglia and cortex.


Rubella

I. Plain X-Ray:

- Microcephaly.


Rubella

II. US:

- Subependymal cysts.

Echogenic foci of

calcifications.


III. CT:

- Microcephaly.

- Calcifications in cortex and

basal ganglia.

Rubella


Rubella

IV. MRI:

- Deep and sub-cortical

lesions.

- Delayed myelination.


Herpes Simplex

Pathology:

- Type 2 in 90%.

- Neonatal infection.

- Diffuse brain involvement.

- Predilection to the endothelial lining of vessels.

- No predilection to limbic system.


Herpes Simplex

Clinical:

- Infants with HSV develop symptoms in the first

week of life and typically present at 10-17 days.

- Newborns tend to present with 3 patterns, as follows:

• Category 1: The disease is limited to the skin, mouth, and eyes.

• Category 2: Primary CNS involvement is present.

• Category 3: Disseminated disease involving the CNS, lung, liver, skin, and eyes is observed.


Herpes Simplex

I. Plain X-Ray:

Plain radiographs are not useful in

assessing HSV encephalitis.


Herpes Simplex

II. CT:

- In acute infections, focal or diffuse white matter lucency

with accentuated relative

hyperdensity of the grey matter. Hemorrhagic infarctions

may occur.

- Involvement is in the periventricular white matter,

sparing the medial temporal and inferior frontal lobes.

- In addition, meningeal enhancement may be observed

following contrast.


Herpes Simplex

III. MRI:

- In neonates, Hypointense T1/

Hyperintense T2 lesions in the

periventricular white matter, with

the medial temporal and inferior

frontal lobes spared.


Herpes Simplex

III. MRI:

- Meningeal enhancement also may

be observed.

THANK YOU

brain infections 1

Health & Medicine

curvilinear calcifications

periventricular areas

neuronal migration anomalies

microcephaly eggshell

parasitic infections

brain destruction

abnormal neuronal migration

basal ganglia