Dados do Trabalho

Título

NEUROIMAGING IN PEDIATRIC NEUROINFECTION

Introdução

Infections of the central nervous system (CNS) in the pediatric age group are significant causes of morbidity and mortality. Early recognition and treatment of these conditions are essential to prevent or minimize brain damage, as the disease can progress rapidly. Neuroimaging evaluation using computed tomography (CT) and magnetic resonance (MR) imaging are valuable tools in assessing these patients. Based on imaging characteristics, it is possible to establish diagnostic hypotheses or at least guide appropriate diagnostic procedures.

Objetivo

This study aims to illustrate the imaging aspects of CNS infections in the pediatric age group using data from a tertiary university hospital over seven years, with confirmed etiological agents.

Método

This is a retrospective cross-sectional study aiming to review neuroimaging aspects in CNS infections among pediatric patients in cases where the etiological agent has been confirmed.

Resultados

During the study period, 117 cases of likely CNS infection were recognized in the pediatric group, among which only 21 had confirmed etiological agents. Of these, 8 were caused by viral agents, with only 4 confirmed by cerebrospinal fluid analysis: 1 case of meningoencephalitis caused by the mumps virus, 2 cases of herpes simplex virus type 2 meningoencephalitis, and 1 caused by SARS-CoV-2. In this study, 12 cases were caused by bacterial infections (meningitis n=10; pyogenic abscess n=1; multiple tuberculomas n=1). One case was caused by a parasitic infection (neurocysticercosis). Imaging findings included leptomeningeal enhancement (on post-contrast T1-WI and FLAIR sequences) observed in 9 cases of bacterial meningitis; the pyogenic abscess showed restricted diffusion in the necrotic component; tuberculosis nodules showed hypointensity on T2-WI and post-contrast enhancement; in neurocysticercosis, multiple scattered cysts were observed, some with a scolex.

Conclusão

Despite the extensive study, even in a tertiary university hospital, it was noted that the vast majority of cases did not have a confirmed etiology (96 out of 117 cases). However, the imaging studies were useful in guiding the correct diagnosis in cases of bacterial meningitis, pyogenic abscess, neurotuberculosis, and neurocysticercosis.

Referências

1. Vasconcelos Miranda TA, Tsuchiya K, Lucato LT. Imaging of Central Nervous System Parasitic Infections. Neuroimaging Clin N Am. 2023 Feb;33(1):125-146. doi: 10.1016/j.nic.2022.07.013. PMID: 36404040.
2. Singhi, P., & Sankhyan, N. 2018. Febrile encephalopathy. Journal of the International Child Neurology Association, 1(1), 9. https://doi.org/10.17724/jicna.2018.11
3. Suthar R, Sankhyan N. Bacterial Infections of the Central Nervous System. Indian J Pediatr. 2019 Jan;86(1):60-69. doi: 10.1007/s12098-017-2477-z. Epub 2018 Jan 3. PMID: 29297142.
4. Gao B, Zee CS. Neuroinfection & neuroimmunology: New opportunities, new challenges. Radiol Infect Dis. 2016 Jun;3(2):51-53. doi: 10.1016/j.jrid.2016.03.008. Epub 2016 Apr 4. PMID: 32289069; PMCID: PMC7128164.
5. Nickerson JP, Richner B, Santy K, Lequin MH, Poretti A, Filippi CG, Huisman TA. Neuroimaging of pediatric intracranial infection--part 1: techniques and bacterial infections. J Neuroimaging. 2012 Apr;22(2):e42-51. doi: 10.1111/j.1552-6569.2011.00700.x. Epub 2012 Feb 3. PMID: 22304299.

Palavras Chave

Neuroimaging; neuroinfections; central nervous system bacterial infections