Neuroimaging clinics of North America
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Infections of the spine represent a rare but potentially debilitating and neurologically devastating condition for patients. Early diagnosis, imaging, and intervention may prevent some of the more critical complications that may ensue from this disease process, including alignment abnormalities, central canal compromise, nerve root impingement, vascular complications, and spinal cord injury. This article reviews the underlying pathophysiologic basis of infection, clinical manifestations, and imaging modalities used to diagnose infections of the spine and spinal cord.
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In cases of central nervous system infection, it is crucial for the neuroradiologist to provide an accurate differential diagnosis of the possible pathogens involved so that treating physicians can be aided in the choice of empiric therapy. This approach requires the radiologist to be aware of local epidemiology and have knowledge of infectious agents that are endemic to their area of practice. This article reviews and discusses the changing epidemiology of pathogens most often observed in meningitis, brain abscess, epidural abscess, postoperative infections, and human immunodeficiency virus infection.
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Radiology provides valuable gross pathologic information about central nervous system (CNS) infections. Major categories of infectious lesions of the brain and spinal cord are recognized by imaging such as diffuse, focal, or multifocal. ⋯ It illustrates examples with gross and microscopic photographs of CNS infections, and the tissue reactions to these infections. Where the organism can spread within the CNS, and cellular responses to the organism underlie both the radiographic and pathologic findings.
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Neurocysticercosis (NCC) is an infection of the central nervous system by the Taenia solium larvae, and is the most common cause of acquired epilepsy in endemic regions. The natural history of parenchymal NCC lesions can be divided into 4 stages with unique imaging and clinical features. Evaluation of cysticerci is challenging on conventional magnetic resonance (MR) imaging and computed tomography, and is significantly improved with MR cysternography techniques. Differentiation of NCC lesions from metastatic disease and pyogenic abscesses can be improved with advanced MR imaging including (1)H nuclear MR spectroscopy, diffusion-weighted imaging, and MR perfusion imaging.
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Central nervous system infections account for 1% of primary hospital admissions and 2% of nosocomial infections and when encountered require prompt diagnosis and initiation of specific treatment. Imaging findings are mostly nonspecific with respect to the causative pathogen. This article describes the anatomy of cranial meninges and extra-axial spaces of the brain. Characteristic findings and recent advances in neuroimaging of meningitis and its complications and ventriculitis are summarized, and certain noninfectious causes of meningitis and meningitis mimics are described.