中枢感染教学课件.ppt

* * * * * * * * * * * * * * Herpes meningoencephalitis Typically demonstrate temporal lobe involvement, often with putaminal sparing Can find RBC in tap Early treatment crucial DWI more sensitive in early disease Viral Infection: Herpes Viral Infection: Herpes Viral Infection: Herpes Viral Infection: Herpes * * Thank you！ * * Same patient * * How to differentiate from glioma Surgical service Central Nervous System Cerebral Abscess Brain abscesses may be related to infections of the paranasal sinuses, mastoids, middle ears as well as hematogenous seeding, but in 20% of cases a source is not discovered. Presenting symptoms of a cerebral abscess include headache, drowsiness, confusion, seizures and focal neurologic deficits. Fever and leukocytosis are common during the invasive phase of a cerebral abscess but may resolve as the abscess becomes encapsulated. * * Cerebral abscess Rim enhancement –thinning towards ventricular aspect Daughter lesions Hypointense T2 rim Restricted diffusion of content may reflect density of inflammatory cells MRS: lactate (1.3 ppm) and cytosolic amino acid peaks (0.9 ppm) * * cerebral abscess * * * * * * * * 5 DAYS LATER * * * * Bacterial Infection: Pyogenic Infection Gupta RK et al. AJNR 2001; 22: 1503 - 1509.  * * Meningitis Role of imaging: identify complications Sensitivity of MR imaging improved with postcontrast FLAIR imaging, fat saturation T1WI Look for hydrocephalus, abscess formation, infarct, ventriculitis Bacterial Infection: Pyogenic Infection Bacterial Infection: Pyogenic Infection Bacterial Infection: Pyogenic Infection Bacterial Infection: Pyogenic Infection Bacterial Infection: Pyogenic Infection Bacterial Infection: Pyogenic Infection * * Epidural abscess Typically due to extension from external source (sinuses, mastoid air cells) or following trauma/surgery Dura often prevents associated parenchymal involvement Look for evidence of source of infection and associated cerebritis Bacterial Infection: Pyogenic Infecti