ABSTRACT
Introduction: CNS infections are an emerging health problemwith poor prognosis if the treatment is not prompt andadequate. Thus, establishing a correct diagnosis is necessaryto quickly start the appropriate treatment. This study wasundertaken to study the etiology and the imaging spectrum ofCNSI in and around western Uttar Pradesh in a tertiary healthcare set up and to correlate the neuro-imaging findings withclinic-pathological data.Material and Methods: In this Prospective Observationalstudy 80 patients clinically suspected of CNS infection werestudied by CT/MRI and the neuro imaging findings werecorrelated with clinical and CSF findings.Results: Based on clinical features, CSF findings, thetreatment given and the response to treatment tuberculousinfection (TBM) was most common infection (41.2%)followed by pyogenic meningitis (36.2%) and viral infection(22.5%). In 29 patients of pyogenic CNS infection mostcommon imaging finding was leptomeningitis(62%)followed by pachymeningitis (31%), hydrocephalus (24.1%),abscess (6.8%), post vasculitic infarct(6.8%) and extra axialcollection(6.8%). In 33 patients of tubercular CNS infectionmost common imaging finding was basal leptomeningitis(78.7%) followed by tuberculoma (72.7%), pachymeningitis(33.3%), hydrocephalus (27.2%), abscess (12.1%), postvasculitis infarct (12.1%) and spinal cord involvement in1 (3%) patient. In the 18 viral CNS infection cases mostcommon imaging finding was parenchymal hyperintensity onMRI or hypodensity on CT with/without peripheral vasogenicedema (94.4%) followed by leptomeningeal/pachymeningealinvolvement (61.1%) and post vasculitis infarct (11.1%).Conclusion: The sensitivity of neuroimaging in pyogenicCNS infection was 81.2% and specificity was 93.7% whilesensitivity of neuroimaging in tubercular CNS infection was88.8% and specificity was 97.8% and in viral CNS infectionsensitivity was 84.2% and specificity was 96.7%. There wassignificant association (p value <0.05) of basal leptomeningitisand granulomas on imaging with tubercular infection andparenchymal signal changes with viral infections