Intracranial infections – 5 – Other
There are a few other infectious considerations which have special imaging appearances and which you should keep in mind. This includes neurocysticercosis and Creutzfeldt-Jakob disease (CJD).
This lecture is the final in a series of 5 about imaging intracranial infection and covers diffuse brain infections. The series of videos will cover:
1) General considerations
2) Diffuse infections
3) Focal infection
4) Immunocompromised patients
5) Other considerations
Neurocysticercosis is a brain infection caused by the pork tapeworm. It is a common infection in Latin America and is a common acquired cause of seizure. While the imaging appearance varies with stage, it most commonly has a cystic lesion in the brain parenchyma with peripheral enhancement and surrounding edema. Racemose cysticercosis can involve the CSF spaces, including the ventricles or sylvian fissures. Chronic cysticercosis commonly has punctate peripheral calcification, which can be a clue in patients with this infection.
Creutzfeldt-Jakob disease (CJD) is a prion disease which is commonly thought of as infection because of its association with contaminated beef (bovine spongiform encephalopathy), but most cases (approximately 85%) are spontaneous, with the remainder familial/inherited. Image findings include bilateral symmetric abnormalities of the basal ganglia and thalamus, including signs such as the pulvinar sign or hockey stick (describing thalamic involvement). Cortical linear involvement, or cortical ribboning, is also common.
In summary, there are a variety of infections in the brain ranging from meningitis/encephalitis through focal infections such as abscess and PML. Awareness of these infections is necessary to make an appropriate diagnosis in these patients.
The level of this lecture is appropriate for radiology residents, radiology fellows, and trainees in other specialties who have an interest in neuroradiology or may see patients with CNS infections.