Lim T, ed. Mukherji SK, consulting ed. Neuroimaging Clinics: Central Nervous System Infections. Theclinics.com; 2023;33(1):1–234; Online and print $413.00; Online only $359.00
With a compilation of common and far less common infectious diseases of the central nervous system, the current issue of Neuroimaging Clinics draws on the expertise of neuroradiologists and clinicians from around the world who are involved in the diagnosis and treatment of CNS infections to produce this well-crafted volume.
Dr. Tchoyoson Lim and Dr. Suresh Mukherji have selected 13 important chapters with contributions from 32 authors. Readers of this volume will have the latest information primarily on the diagnosis of these multifaceted infections. The chapters in order are: The Changing Epidemiology of CNS Infections; Neuroimaging Patterns of Intracranial Infections; Structured Imaging Approach for Viral Encephalitis; Acute Neurological Complications of Coronavirus Disease; Coronavirus Disease: Subacute to Chronic; Imaging of Uncommon Bacterial, Rickettsia, Spirochete, and Fungal Infections; Imaging of CNS Parasitic Infections; HIV: Opportunistic Infections and Beyond; Spinal Infections; Imaging of Head and Neck Infections; Imaging of Congenital/Childhood CNS Infections; and Beyond Pattern Recognition: Radiology-Pathological-Clinical Correlation.
The first chapter sets the stage for what is to follow in subsequent topics, and that chapter is particularly germane to today’s world, where the microenvironment and the world of microorganisms are in constant flux. Probably in no other area of neuroimaging does the substrate for the underlying diseases change so rapidly. By looking at the above table of contents, one gets the sense that this is a critical volume of Neuroimaging Clinics. While much of the information is available in a variety of published articles, this volume draws all of this together under one roof.
Showing abundant examples of what one may encounter in intracranial infections, the second chapter is an excellent introduction to all the modalities and techniques used in patient evaluation. The authors show many examples, including MRS, NM, DWI, and routine imaging. All of this is complemented by summary boxes (12 in total), which place in context the material found in this chapter. Before diving into the remaining material in this volume, one should spend time carefully examining the figures.
From there the volume takes us to the often complex world of viral infections (3 chapters) and their imaging patterns. All readers will be focused on the 2 chapters related to COVID—1 on neurologic complications and the other on the subacute-to-chronic neuroimaging findings. The protean nature of this pandemic disease from both a clinical aspect and an imaging standpoint borders on necessary reading for all neuroradiologists. As this disease morphs into different variants, we may identify altered imaging manifestations, particularly in the long-haulers.
An appropriately long chapter (20 pages) on infections caused by bacteria, rickettsia, and fungi lets the reader see variable parenchymal and meningeal patterns, many of which are uncommonly encountered. The apparent rebound of TB and its worldwide distribution make it important to focus on the important chapter concerning mycobacteria. Just like the clinical aspects are multifaceted, so are the neuroimaging findings. The authors nicely describe and illustrate the different findings, including tuberculous leptomeningitis, tuberculous pachymeningitis, tuberculomas (all 4 stages), abscesses, tuberculous cerebritis, and vasculitis in brain involvement. The authors also show the various types of TB spinal disease, including spondylitis, spinal meningitis, and intramedullary involvement (myelitis/tuberculomas of the spinal cord). This is a must-read chapter because throughout the world all of these findings are seemingly becoming more frequent. Chapters on the human immunodeficiency virus and imaging of CNS parasitic infections sit nicely side by side. A wonderful review of HIV dementia, opportunistic infections, PML, IRIS, and CD 8 encephalitis, among other details, gives a grand overview of the subject.
From the brain, the reader is taken to chapters on spine infections and head and neck infections. The latter includes temporal bone, salivary gland, sinonasal, oral cavity, and sublingual/submandibular/pharyngeal/glottic infections. While there are some areas of overlap with material earlier in the book, the penultimate chapter on childhood CNS infections runs the gamut of such diseases with an emphasis on viral etiologies. The material is discussed in such a manner that it broadens our knowledge of all manner of infections. By ending this volume with a discussion of radiology/pathology/clinical correlations, one can obtain an overview of infections that allows radiologists to consider (particularly pathologic) aspects of infections with which we infrequently deal.
There are so many good portions of this volume that it is difficult in a review to highlight them all, but here are just a few. In the 2 chapters on COVID, the acute, subacute, and chronic symptoms and imaging findings are discussed and illustrated. In both, the basic underpinning of the disease allows us to more fully understand why there are a host of imaging findings, particularly those related to ACE2 receptors in vascular endothelium, glial cells, and brainstem nuclei. The mode of initial involvement and subsequent spread gives rise to a host of abnormalities that have imaging correlates and are nicely illustrated. Some of these are subtle, such as tiny microhemorrhages at cortical medullary junctions and perhaps also the axonal neuropathies. All images in these chapters should be scrutinized, and while most of these findings can be seen in patients without COVID, the chapters make us aware of the gamut of abnormalities. The chapter on viral encephalitis is another excellent chapter, not only because of the examples shown, but also because of the charts and tables, 1 of which is a flowchart that divides viral diseases into acute and subacute/chronic disease courses and then further divides these into MRI patterns and then shows which pattern reflects which viral infection. The comments in this paragraph are just snippets of what can similarly be found in the other chapters.
Many issues of Neuroimaging Clinics make for informative reading, but none are more indispensable than this issue. The disease descriptions and the illustrations serve as a guidepost for all neuroradiologists. Dr. Lim has done a masterful job in putting critical chapters into this volume. This issue is recommended in the highest terms.
