Learning objectives
To illustrate the classic imaging appearances of various fungal neuroinfections
To summarise the key imaging pearls useful in our day to day practise.
Background
There is an increase in the incidence of CNS fungal infection because of an EVER-increasing pool of immunocompromised hosts.
Today, fungal infection is not rare and can be anticipated in specific clinical settings.
Recognition of imaging features may facilitate early diagnosis and prompt therapy.
Clinical presentation:
Nonspecific
Fever, meningism, focal neurologic defects, seizures, alterered mental status and lack of response to broad spectrum antibiotics.
Rhinocerebral syndrome: nasal discharge, orbital pain, facial edema, vision disturbances, proptosis
CVA
Concurrent pulmonary infection
Findings and procedure details
SPECIFIC IMAGING FINDINGS
YEASTS
1. Neurocandidiasis:
Candidiasis: most common nosocomial fungal infection worldwide.
Most common intrauterine/neonatal fungal infection
C Albicans - normal constituent of human gut flora
Susceptible individuals –> Disseminated haematogenous infection
Imaging Pearls: Scattered T1 hyperintense, diffusion restricting foci without SWI blooming in basal ganglia and subcortical region in a neonate is the most common presentation of candida microabscess
2.CNS Cryptococcosis
C. neoformans
most common fungal infection and second most common opportunistic infection of the central nervous system
commonly found in soil, especially...
Conclusion
When to suspect CNS fungal infection:
Immunocompromised
Soap bubly lesions in basal ganglia in HIV patients.
Minimal leptomeningealenhancement
Peripheral rim/Intracavitory projection showing diffusionrestriction.
Hemorrhagic foci in the lesion.
Weak ring enhancement.
Associated hemorrhagic or ischemic stroke
Comcommitant paranasal (Black turbinate) or Mastoid disease
Concommitant Pulmonary infection.
Imaging plays acentral role in early diagnosis of fungal neuroinfections.
Personal information and conflict of interest
S. Patwari; Bangalore/IN - nothing to disclose H. C. Chadaga; Bangalore, KA/IN - nothing to disclose R. Sutanto; Tangerang/ID - nothing to disclose R. Hassan; Bangalore/IN - nothing to disclose
References
Starkey J,Moritani T,Kirby P: MRI of CNS fungal infections: review of aspergillosis to histoplasmosis and everything in between:Clin Neuroradiol.2014 Sep;24(3):217-30. doi: 10.1007/s00062-014-0305-7. Epub 2014 May 29.
