Neonatal brain infections

Abstract

Infections of the brain in the neonatal period differ considerably from infections in the older child, due to a variety of age-specific factors that are related not only to the child, but also to the mother, and to specific pathogenic organisms. It has been recognized that clinical and neurological signs are often non-specific, sometimes scarce, and seldom correlate with the extent of neuroimaging findings, thus warranting early imaging to ensure timely therapy and improved outcome.

Neuroimaging of Pediatric Intracranial Infection—Part 2: TORCH, Viral, Fungal, and Parasitic Infections

“…Multifocal areas of restricted diffusion within the white matter are reported, in addition small areas of susceptibility artifact have been seen suggesting that these encephalitides may become hemorrhagic 54 . Coxackievirus and poliovirus show a predilection for the anterior horn cells within the spinal cord as well as the medulla, pons, and cerebellum accounting for the propensity to cause motor disturbances 18 …”

“…The HSV‐2 virus is associated with a greater degree of morbidity than the HSV‐1 strain. Unlike the adult manifestations of HSV infection, in the neonate the frontal and temporal lobes may not be as preferentially involved and rather the deep and periventricular white matter may be affected 18 . In addition, hemorrhage is rarely seen in the setting of congenital HSV infection.…”

“…Several members of the Picornaviridae family that include parechovirus, coxackievirus, poliovirus, and echovirus, have been reported to result in encephalitis in children. Infections by these agents are associated with severe neurologic damage and poor outcome 18 . Most children are infected before the age of 5 years with coxackievirus and echovirus, infections are often seen in the late summer or fall 31,53 .…”

“…Fungal infection of the pediatric CNS are most frequently seen in the extremely premature neonate or in immunocompromised children 18 . In the case of the premature neonate, fungal infection ranks third behind TORCH infection and bacterial meningitis as a cause of infectious encephalopathy 8 .…”

“…These patients typically have poor clinical outcomes 63 . Imaging findings may include the presence of diffuse parenchymal lesions throughout the supratentorial and infratentorial brain as well as occasionally within the ventricles with a varying degree of associated enhancement depending on the ability of the host to mount an immune response 18 . Under appropriate treatment, the imaging changes may regress over a time course of up to 6 months.…”