Imaging of cerebrovascular complications of infection

Abstract

Cerebrovascular complications may occur in infectious diseases in the setting of infective endocarditis, central nervous system (CNS) infections, systemic bacteremia and sepsis. Cerebrovascular complications of infections include vasculitis, mycotic aneurysms, and thrombophlebitis. Infectious vasculitis of the CNS may cause cerebral hemorrhage, infarction or ischemia. Ruptured aneurysms may endanger the patient's life. Infectious thrombophlebitis may cause intracranial pressure to increase and lead to cerebral hemorrhage. These cerebrovascular complications are associated with a poor prognosis and often cause irreversible neurological deficits. Cerebrovascular events secondary to infection are not easily distinguishable from the more common cerebral infarct and non-infectious vasculitis. In addition, the clinical manifestations of cerebrovascular complications of infections are non-specific and highly variable. Therefore, early imaging, antibiotics, and anticoagulation may be lifesaving the patient's life and prevent disability. The main focus of this article is to review imaging analysis of the cerebrovascular complications of infections and imaging features that help differentiate them from non-infectious vascular diseases.

MR vessel wall imaging in cerebral bacterial and fungal infections

“…We found maximum number of infarcts in the MCA territory ( n = 5, 41.7%) and watershed territories ( n = 3, 25%). Previous studies have shown that infarcts are multiple and typically formed at deep gray nuclei, gray–white junction, and thalami [ 4 ]. We also found such multiple focal infarcts in 3 cases.…”

“…Unruptured mycotic aneurysms are primarily managed by antibiotics/antifungals and if they respond to medical treatment with reduction in size in follow-up imaging, then endovascular management is not required. However, increase in size or appearance of new aneurysms mandates interventional treatment [ 4 ].…”

“…Imaging evaluations should be directed to detect these complications in early stage for better disease prognostication. Mechanisms of vascular involvement include infiltration of vessels by basal exudates, extension of inflammation via meninges, hematogenous spread via vasa vasorum, immune-mediated, toxic effects of released endotoxin or exotoxin by inciting organisms, or infection-induced procoagulant state [ 1 , 3 , 4 ]. Inflammation of the vessel wall leads to circumferential mural thickening, stenosis, beading, or thrombosis.…”

Common infectious diseases of the central nervous system—clinical features and imaging characteristics

“…Other commonly reported sources of septic emboli include sepsis from intravenous drug use, infection of instrumental devices such as indwelling catheter or pacer wires, pulmonary abscess, etc. (44)(45)(46).…”

The Use of Intracranial Vessel Wall Magnetic Resonance Imaging to Detect a Presumptive Syphilitic Brain Aneurysm

“…It is one of the manifestations of neurosyphilis that occurs in 15% to 23% of patients with neurosyphilis on an average of 5 to 10 years after the initial contraction. [4][5][6] Patients with meningovascular syphilis can present with stroke syndrome, even in the absence of the traditional vascular risk factors. These presentations can be caused by a variety of vascular abnormalities, including vascular stenosis, aneurysms, or thrombosis leading to ischemic stroke.…”