Pediatric Intracranial

Infections
Hemant Parmar, MD*, Mohannad Ibrahim, MD

KEYWORDS
 Pediatric  Intracranial  Infection  Congenital  Complications

KEY POINTS
 As in adults, imaging is crucial to look for complications of intracranial infection.
 In very young children, the clinical features of intracranial infection are nonspecific and imaging
may help in suggesting a diagnosis.
 Cytomegalovirus is the commonest type of congenital infection.
 Infectious bacterial meningitis is the commonest type of intracranial infection in children.
 In patients with recurrent episodes of meningitis, it is important to look for a possible osteodural
break, like spinal dermal sinus or nasal dermal sinus.

INTRODUCTION virus [HIV]), rubella, cytomegalovirus (CMV), and

Infection of the central nervous system (CNS) in
children is an important entity and early recognition
is paramount to avoid long-term brain injury, espe-
cially in very young patients. The causal factors are
different in children compared with adults and so
are the clinical presentations. However, imaging
features of CNS infection show similar features to
those of adults. This article reviews some of the
common types of pediatric infections, starting
with the congenital (or in utero) infections followed
by bacterial infections of the meninges and brain
parenchyma. The viral infections are also reviewed.
CNS tuberculosis and fungal and parasitic infec-
tions are discussed separately in this issue and
are not discussed in this article.
CONGENITAL INFECTIONS
Congenital infections are transmitted to the fetus
from the mother through the transplacental route or
during birth. The mnemonic TORCH is often used
herpes simplex virus (HSV) type 2. All these are
transmitted to the fetus from primary maternal infec-
tions, except for herpes, which is acquired during
parturition. It is important to realize that infections
of the fetus have long-term effects and sequelae
on the developing brain. These sequelae depend
on the fetal age at the time of infections, the cellular
susceptibility to the infecting agent and host immune
responses. Insults in the first or second trimesters
typically result in CNS malformations (like micro-
cephaly, lissencephaly, or polymicrogyria), whereas
infections in the third trimester result in destructive
lesions like aqueductal stenosis and hydrocephalus,
porencephaly, multicystic encephalomalacia, calci-
fications, demyelination, and atrophy.1–3
Toxoplasmosis
Toxoplasmosis is caused by Toxoplasma gondii, an
intracellular parasite that infects birds and
mammals. Cats usually serve as primary hosts for
the parasites. Domestic animals like pigs and cattle
neuroimaging.theclinics.com

to describe these entities, which stands for toxoplas- serve as intermediate hosts. Human infection
mosis, others (syphilis, human immunodeficiency occurs through consumption of undercooked,

Disclosure: The authors report no conflicts of interest.

Division of Neuroradiology, Department of Radiology, University of Michigan Health System, 1500 East Medical
Center Drive, Ann Arbor, MI 48109-0302, USA
* Corresponding author.
E-mail address: hparmar@umich.edu

Neuroimag Clin N Am 22 (2012) 707–725

http://dx.doi.org/10.1016/j.nic.2012.05.016
1052-5149/12/$ – see front matter Ó 2012 Elsevier Inc. All rights reserved.