Brain Infections 1

1. Infections of
the Brain and
Meninges
Mohamed Samir
Assisst. Lecturer

2. Infections
Congenital / Neonatal Acquired
• Cytomegalovirus.
• Toxoplasmosis.
• Rubella.
• Herpes Simplex.
• HIV Infection.
• Enteroviruses.
• Meningitis.
• Pyogenic
Parenchymal
Infections.
• Encephalitis.
• TB & Fungal
Infections.
• Parasitic Infections.

3. Congenital/Neonatal
Infections

4. Congenital/Neonatal InfectionsCongenital/Neonatal Infections
• Agent:
TORCH
Toxoplasmosis.
Rubella.
Cytomegalovirus.
Herpes Simplex.
HIV
Syphilis

5. Congenital/Neonatal InfectionsCongenital/Neonatal Infections
Route of Infection:
• Transplacental.
• Through birth canal.
• Ascending cervical.

6. Congenital/Neonatal InfectionsCongenital/Neonatal Infections
Effects:
• Malformations.
• Brain Destruction.
• Dystrophic calcifications.

7. Cytomegalovirus
I. Congenital/Neonatal Infections
Pathology:
- Affinity for the developing germinal matrix.
- Widespread periventricular necrosis and
subsequent dystrophic calcifications.
- May cause abnormal neuronal migration.

8. Cytomegalovirus
I. Congenital/Neonatal Infections
I. Plain X-Ray:
Microcephaly + Eggshell-like
periventricular
calcifications.

9. Cytomegalovirus
I. Congenital/Neonatal Infections
I. Plain X-Ray:
Microcephaly + Eggshell-like
periventricular
calcifications.

10. Cytomegalovirus
I. Congenital/Neonatal Infections

Bilateral periventricular
calcifications.

Widespread cerebral destruction
and encephalomalasia.
II. US:

11. Cytomegalovirus
I. Congenital/Neonatal Infections
II. US:

12. Cytomegalovirus
I. Congenital/Neonatal Infections
 Atrophy & Ventricular
Enlargement.
 Periventricular Calcifications.
 Neuronal Migration Anomalies.
III. CT:

13. Cytomegalovirus
I. Congenital/Neonatal Infections
As in CT +
 Neuronal Migrational Anomalies.
 Delayed Myelination.
 Subependymal Paraventricular
Cysts & Calcifications.
IV. MRI:

14. Cytomegalovirus
I. Congenital/Neonatal Infections
IV. MRI:

15. Cytomegalovirus
I. Congenital/Neonatal Infections
Associated features:
 Hepatosplenomegaly.
 Jaundice.
 Chorioretinitis.

16. WHY MEN DIE BEFORE
WOMEN!

17. I. Congenital/Neonatal Infections
Toxoplasmosis
Pathology:

Triad of: Hydrocephalus, Calcifications and Chorioretinitis.

Multifocal and scattered.

Necrosis & Calcification

No migration anomalies.

18. I. Congenital/Neonatal Infections
Toxoplasmosis
I. Plain X-Ray:

19. I. Congenital/Neonatal Infections
Toxoplasmosis
II. US:

20. I. Congenital/Neonatal Infections
Toxoplasmosis
-Hydrocephalus.
- Multiple, irregular, nodular, cyst-like
or curvilinear calcifications in the
periventricular areas and the choroid
plexus.
III. CT:

21. I. Congenital/Neonatal Infections
Toxoplasmosis
-Hydrocephalus.
- Multiple, irregular, nodular, cyst-like
or curvilinear calcifications in the
periventricular areas and the choroid
plexus.
III. CT:

22. I. Congenital/Neonatal Infections
Rubella
• Pathology:
- Inhibits cell proliferation and myelination.
- Prominent ocular abnormalities.
- Calcifications in basal ganglia and cortex.

23. I. Congenital/Neonatal Infections
Rubella
I. Plain X-Ray:
- Microcephaly.

24. I. Congenital/Neonatal Infections
Rubella
II. US:
- Subependymal cysts.
Echogenic foci of
calcifications.

25. I. Congenital/Neonatal Infections
III. CT:
- Microcephaly.
- Calcifications in cortex and
basal ganglia.
Rubella

26. I. Congenital/Neonatal Infections
Rubella
IV. MRI:
- Deep and sub-cortical
lesions.
- Delayed myelination.

27. WHY MEN DIE BEFORE
WOMEN!

28. I. Congenital/Neonatal Infections
Herpes Simplex
Pathology:
- Type 2 in 90%.
- Neonatal infection.
- Diffuse brain involvement.
- Predilection to the endothelial lining of vessels.
- No predilection to limbic system.

29. I. Congenital/Neonatal Infections
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.

30. I. Congenital/Neonatal Infections
Herpes Simplex
I. Plain X-Ray:
Plain radiographs are not useful in
assessing HSV encephalitis.

31. I. Congenital/Neonatal Infections
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.

32. I. Congenital/Neonatal Infections
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.

33. I. Congenital/Neonatal Infections
Herpes Simplex
III. MRI:
- Meningeal enhancement also may
be observed.

34. WHY MEN DIE
BEFORE WOMEN!

35. THANK YOU