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Neuroradiology

Cerebritis

the early stage of a brain infection, that most frequently leads to abcess formation.

Pyogenic bacteria, streptococci and staphylococci, as well as proteus, pseudomonas and Gram-negative organisms, are found.They reach the CNS via different ways: direct haematogenous spread, retrograde phlebitis from sinus or mastoid infections and trauma.

Cerebritis undergoes different stages of evolution if not successfully controlled by therapy; from an early stage characterized by congested vessels, perivascular polymorphonuclear cell infiltrates with surrounding oedema, to a late stage with necrosis that leads to abscess formation (see abscess cerebral) with central liquefaction and peripheral collagenous and gliotic capsule formation.

CT and MR show all the different stages with abnormal density/intensity of the affected tissue and progressive enhancement when the abscess forms (Fig.1).

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Fig.1

a, b. MRI, T2-weighted image. Marked hyperintensity of the left frontal cortex, due to cerebritis secondary to intracranial extension of frontal sinusitis. A posterior interhemispheric collection along the falx is also seen, as well as posterior mesial frontoparietal involvement. c. MRI, T1-weighted coronal section. The interhemispheric subdural collection (empyema) is isointense (arrows). d. Contrast-enhanced CT shows cortical hypodensity and slight enhancement of the capsule of the subdural empyema.
Cerebritis, Fig.1 (a)
Cerebritis, Fig.1 (b)
Cerebritis, Fig.1 (c)
Cerebritis, Fig.1 (d)