Role Of Imaging In Intracranial Infections And Infestations
Imaging In Intracranial Infections And Infestation
DOI:
https://doi.org/10.70284/njirm.v6i6.1017Keywords:
CNS Imaging, CT, Tuberculoma, Neurocysticercosis, Brain Abscess, Meningitis, MRIAbstract
Background and Objective: Conventional X –rays and cranial ultrasound have limited role in central nervous system infections and infestations, neuroimaging with CT and MRI plays significant role in understanding and diagnosing these diseases. The aims and objectives of this study are to study the CT and MRI appearance in CNS infection and infestations according to the age, sex, location, duration etiology and to analyze clinico-pathological confirmation with imaging findings and to evaluate their accuracy in final diagnosis. Methodology: This prospective study of 120 patients of all age group with no gender bias, religion or socio-economic status except pregnant patients and patients having allergy to contrast material, patients with cochlear implants, cardiac pacemaker and Ferro- magnetic orthopedic implants was done during January 2014 to June 2015 using non-contrast and contrast enhanced CT and MRI scans. Result: In this study of 120 patients, CNS infection occurred maximum between 1 – 10 years of age (26.67%) followed by the group 21-30 years (21.67%). The ratio of male: female was found to be 1.07:1. Fever emerged as the overall most common presenting clinical symptom and generalized tonic clonic convulsions as the most common neurological symptom. Supratentorial lesions were more frequent (96.67%) Non contrast MRI was found to be more effective in detection of the CNS pathology together with hemorrhage (80% of cases). Non- contrast CT scan proved to be very accurate in detection of calcification (60%) while MRI was positive only in 40% of cases. MRI proved to be more positive in detection of edema (84.21%) unlike CT which showed only 15.67%. On post contrast MRI picked up 55% of cases with ring lesions while CT was able to detect them only in 45% of cases. MRI detected meningeal enhancement of 72.2% cases and mass effect in 76.1% of cases. While CT detected meningeal enhancement of CNS (27.78%) and mass effect in 23.08% cases. Conclusion: MRI provided better sensitivity with clinic- pathological correlation which can guide clinicians in treatment and prognosis while CT scan can be used as an initial modality of investigation and it has advantage of being done in few seconds. The comparisons were made between diabetic females of both the phases (menstruation and menopause) and age matched non-diabetic females. Further comparisons were made between diabetic females of menopause phase and diabetic females of menstruation phase. [Satodia D NJIRM 2015; 6(6):51-58]
References
2. Kirkpatrick B,Reeves DS, MacGowan AP. A review of the clinical presentiation , laboratory features, antimicrobial therepy and outcome of 77 episodes of pneumococcal meningitis occurrig in children and adults. J Infect. 1994 Sep;29(2):171-82
3. Nozika H, Koto A,Amano T,Tanahashi N, Tanaka K,Kobari M,Fukuuchi Y Clinical features of 5 cases of tuderculous meningitis—with special reference to brain CT and MRI findingsKekkaku.1997 Mar; 72:(3):139-46
4. Stefan Kastenbauer and Hans- Welter Pfister Pneumococcal meningitis in adults Spectrum of complications and prognostic factors in a series of 87 cases oxford journal medicine, August 29,2002
5. Davis Kr. New Pf, Solis Oj, Robirson Gh, A Review Of The Findings On Computed Craninal Tomography Fllowing Intrsvenous Contrat Media…Rev Interim Radiol.1977 Jan; 2(1): 15-8.
6. John Hagga ,CT and MRI of whole body 5th edition , Page no: 31-56.
7. Seow Wt, Yeo Tt Ong P1, Tuberculoma of the Brain- Report of 2 Cases and Review of Literature. Mj. 1991 Dec ; 32(6):42730
8. Basoglu OK, Savas R,Kitis O Conventional and diffusion- weighted MR imaging of intracranial tubeculomas. Acase report. Acta Radiol. 2002 Nov; 43(6):560-2.
9. Sonmez G, Ozturk E, Sildiroglu HO, Mutlu H, Cuce F, Senol MG, Kutlu A.Basekim CC,Kizilkaya E. MRI findings of intracranial tuberculomas. Clin Imaging. 2008 Mar-Apr;32(2):88-92
10. Panagariya A, Jain RS,Gupta S,Garg A,Sureka RK, Mathur V. Herpes simplex encephalitis in North West India. Neurol India. 2001 Dec;49(4):3605
11. Post MJ, Tate LG, Quencer RM, Hensley GT, Berger JR, sheremata WA,Maul G. CT, MR, and pathology in HIV encephalitis and meningitis. AJR Am J Roentgenol.1988 Aug; 151(2):373-80.
12. Sawlani V. Diffusion-weighted imaging and apparent diffusion coefficient evaluation of herpes simplex encephalitis and Japaneseencephalitis.J Neurol Sci. 2009 Dec 15; 287(1-2):221-6.Epub 2009 Sep 3.
13. Offenbacher H, Fezekas F, Schmidt R, Kleinert R,Payer F, Kleinert G, Lechner H MRI in tuberculous meningoencephalitis: report of four cases and review of the neuroimaging literature Neurol. 1991 Sep;238(6):340-4.
14. Chen SF, Lu CH, Lui CC, Huang CR, Chuang YC, Tan TY, Tsai NW, Chang CC,Tsai WC, Chang WN. [Acute/sub-acute cerebral infarction (ASCI) in HIV- negative adults with cryptococcal meningoenphalitis (CM): BMC Neurol. 2011 Jan 26;11:12]Bilaniuk, M.D. Paul M. Shipkin, M.D., Donald H. Gilden, M.D., Fredrik Murtagh, M.D, [Evolution of Cerebral Abscess: Correlation of Clinical Features With Computed Tomography Neurology January 1977.]
15. Luken MG 3rd, Whelan MA Recent diagnostic experience with subdural empyema. J Neurosurg. 1980 Jun; 52(6):764-71.
16. Pathak A, Sharma BS,Mathuriya SN, Khosla VK, Khandalwal N, Kak VK Contriversies in the management if subdural empyema. A study of 41 cases with review of literature. Acta Neurochir (Wien). 1990; 102(1-2):25-32.
17. Maytal J, Patel M, Apeatu S, Schneider S, Eviatar L subdural empyeme in 12-year-old girl:the value of magnetic resonance imaging. J Neuroimaging. 1996 Oct; 6(4):258-60.
18. Wong AM, Zimmerman RA, simon EM, Pollack AN, Biianiuk LT Diffusion- weighted MR imaging of subdural empyema in children. AJNR AmJ Neuroradiol. V2004 Jun-Jul; 25(6):1016-21.
19. Lecuit M, Rogeaux O,Bricaire F, Gentilini M[Intracerebral tuberculoma in HIV infection. Epidemiology and contribution of magnetic resonance imaging].Presse Med. 1994 May 21;23(19):891-5]Holtas S, Tomquist C, Cronqvist, [ Diagnostic Difficulties In Computed Tomography Of Brain Abscesses; Computed Assist Tomography 1982 Aug; 6(4):683-8.]
20. Jayakrishnan MP, Krishnakumar P Clinical profile of acute disseminated encephalomyelitis in children.Pediatr Neurosci. 2010 Jul; 5(2):111-4
21. Prayer D, Barkovich A, Kirschner D, et al: visualization of nonstructural changes in early white matter development on diffusion-weighted MR images: Evidence supporting premyelination anisotropy. Am J Neuroradiol 22: 1572-1576, 2001.
22. Gupta RK, Kathuria MK, Pradhan S. Magnetization transfer MR imaging in CNS tuberculosis. AJNR Am J Neuroradiol. 1999; 20:867–75. [PubMed]
