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Acute intracranial infections of the central nervous system and skull base are uncommon but time sensitive diagnoses that may present to the emergency department. As symptoms are frequently nonspecific or lack typical features of an infectious process, a high index of suspicion is required to confidently make the diagnosis, and imaging may not only serve as the first clue to an intracranial infection, but is often necessary to completely characterize the disease process and exclude any confounding conditions. Although computed tomography is typically the initial imaging modality for many of these patients, magnetic resonance imaging offers greater sensitivity and specificity in diagnosing intracranial infections, characterizing the full extent of infection, and identifying potential complications. The aim of this article is to serve as a review of the typical and most important imaging manifestations of these infections that can be encountered in the emergent setting.

Background Intracranial infection is a major cause of emergency and death in children. To assist clinical decision-making in patient management, we conducted a study about factors associated with mortality. This study aimed to evaluate factors associated with mortality in pediatric patients with intracranial infection. Methods We performed a cohort retrospective study in our tertiary hospital to evaluate the outcomes of patients admitted to the pediatric intensive care unit (PICU) from 2014 to 2018. The Chi-square test was performed to determine the significance of the predictor, and p, Highlights • Intracranial infection is a major cause of emergency and death in children. • Recognition of conditions that exacerbate intracranial infection. • The need of mechanical ventilation support in the pediatric intensive care unit.

Introduction: Bacterial meningitis is a severe intracranial infection with a high complication rate. Neurological morbidity relates to parenchymal involvement where vascular mechanisms and stroke may predominate. Here, we systematically identified all neonates and children with bacterial meningitis and compared those with and without MRI-confirmed stroke. We hypothesized that patterns of stroke would correlate with causative organism and neurological outcome. Methods: Population-based (2.2 million), ten-year retrospective (2002-2012) cross-sectional study in Southern Alberta, Canada. Inclusion criteria were: (1) age from newborn (including prematurity) to 18 years, (2) brain MRI including DWI during admission, and (3) laboratory confirmed acute bacterial meningitis. Demographics, clinical presentations, risk factors, and laboratory findings were extracted. Original imaging was blindly reviewed and classified for stroke and injury pattern. Outcomes were extrapolated to the Pediatric Stroke Outcome Measure (PSOM). Results: Twenty-four patients had confirmed bacterial meningitis and acute MRI (6 neonates, 83% male, and 18 children, mean age 3.14+/-3.9 years, 67% male). Arterial ischemic stroke was confirmed in 9/24 (38%). Strokes were often multifocal (89%), particularly in neonates (100%). Subjects with stroke were more likely to have longer duration of illness prior to presentation, meningismus, prolonged fever, seizures, and new focal neurological signs. The most common organisms were S. pneumonia in older children (44%) and group B streptococcus in neonates (33%). Three patients received steroids, 3 ASA and 1 heparin and ASA. Mortality was 22% in children with stroke and zero in those without (p=0.16). Survivors with stroke were more likely to have motor deficit (71% vs. 25%, p = 0.07), cognitive deficit (75% vs. 38%, p = 0.5), and speech deficit (60% vs. 10%, p = 0.08). Conclusions: More than a third of children with bacterial meningitis warranting MRI have stroke. Associations include longer duration of illness, meningismus, focal neurological signs and common causative organisms. Stroke was associated with higher mortality and morbidity, warranting consideration of increased MRI screening and new approaches to treatment.

Summary: The outcome of patients harboring intracranial abscesses has improved in the last decade as a result of improvement in imaging technologies, the introduction of potent antibiotics that penetrate the blood–brain barrier more readily, and minimally invasive surgical techniques with the possibility of image and real-time guidance. These therapeutic advances have, however, been counterbalanced by the increase in immunocompromised patients with pathogens that are more aggressive and difficult to eradicate. This review highlights the current approach to the diagnosis and treatment of intracranial abscesses, emphasizes pitfalls in management, and discusses dilemmas in treatment strategies. Key Words: Brain abscess—Intracranial infection— Surgery—Imaging—Antibiotics—Complications—Outcome.

Rationale: Intracranial infection with Acinetobacter baumannii is a tough problem due to the presence of multiresistance and drugs poor penetration through the blood brain barrier (BBB). Tigecycline is effective to cure A baumannii, but it can only be used intravenously which is also difficult to pass BBB. So, it will be a breakthrough if intraventricular (IVT) tigecycline is used in the clinical therapy. However, this treatment has been reported quite rarely until now. Patient concerns: We described a case of a 50-year-old male worker whose clinical futures were high fever and cerebral rigidity after neurosurgery. Diagnoses: Intracranial infection with extensive drug resistant (XDR) A baumannii. Interventions: The patient was treated with IVT tigecycline. Outcomes: The symptoms of intracranial infection disappeared. The temperature of this patient decreased to normal and cerebral rigidity disappeared. The cerebrospinal fluid culture became negative, with normal levels of white blood cell, glucose and chlorine. Lessons: IVT tigecycline therapy maybe effective to intracranial infection with XDR A baumannii. However, more studies will further demonstrate the therapeutic values of IVT tigecycline to intracranial infection, and not only restricted to A baumannii infections.

This article discusses the neuroradiologic characteristics of central nervous system infections in children. These disorders are divided into two groups: those of congenital infections and those of infections in the infant and child. Congenital infections are referred to by the acronym TORCH. Inflammatory diseases in the infant and child encompass meningitis, cerebritis, and encephalitis. The heterogeneous etiologies often can be suggested by the neuroradiologic findings, as demonstrated with computed tomography and magnetic resonance imaging. This article also addresses the sequelae of destructive brain injuries.

Seizures in the neonatal period are usually concomitants of serious neurological disease. The convulsive phenomena take certain distinctive and often subtle forms because of the status of the neuroanatomical and neurophysiological development of the neonatal brain. The predominant etiological process is hypoxic-ischemic encephalopathy, but intracranial hemorrhage, intracranial infection, developmental defects and metabolic disorders are also responsible for a considerable proportion of cases. Prognosis is related primarily to the neurological disease that underlies the seizures. Treatment may be specific for the underlying disorder, e.g., glucose, calcium, magnesium, pyridoxine, but whatever the cause, urgent control of the convulsions is important because they may have deleterious consequences. Phenobarbital is the single, most important anticonvulsant in the management of neonatal seizures.

Eight per cent of 387 acutely head-injured patients had concomitant orbitofacial injuries. Irrespective of the magnitude of brain injury, the main surgical goals in such cases treated were closure of CSF fistulas, maximizing recovery of eye movement, visual and masticatory function, and esthetic reconstruction. The strictly neurosurgical lesions should be dealt with at once because of the risk of intracranial infection. Antibiotic acrylic and antibiotic wax are valuable in such intervention. In most cases it is advantageous to treat lesions of the upper two thirds of the facial complex in the same operative session. For this reason neurosurgeons who do not have ready access to a maxillofacial specialist should be prepared to cope with the problems presented by orbitofacial injuries.

Intracranial calcification simulating Sturge-Weber syndrome is rare in association with intracranial infection. A case of bilateral gyriform calcification after herpes simplex virus encephalitis evaluated by repeat computed tomography (CT) scans is presented. To our knowledge this is the first published report of CT findings in this entity.