This document discusses various infections that can affect the brain and meninges in congenital and neonatal contexts. It focuses on cytomegalovirus, toxoplasmosis, rubella, and herpes simplex infections. For each one, it describes the pathology, clinical presentation, and key imaging findings on plain X-rays, ultrasound, CT, and MRI. Common imaging features among the infections include calcifications, cysts, white matter abnormalities, and ventricular enlargement. Cytomegalovirus in particular is known to cause periventricular calcifications and cerebral destruction. The document emphasizes that imaging plays an important role in the diagnosis and management of congenital and neonatal brain infections.

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