Armies of Pestilence: CNS Infections as Potential Weapons of Mass Destruction

Neurobrucellosis. Coronal postgadolinium MR imaging (A) shows sellar and suprasellar thickening and enhancement, presumed granuloma formation. Abnormalities resolved after treatment. Axial FLAIR (B) of a different patient shows extensive white matter hyperintensities in a 50-year-old patient. White matter changes in brucellosis may be due to demyelination, perhaps from autoimmune reaction. Meningeal enhancement and vascular changes are also reported in brucellosis. Reprinted with permission from Al-Sous et al.⁴¹

Japanese encephalitis. Axial T2-weighted MR imaging shows bilateral hyperintensity in the thalami and basal ganglia. Reprinted with permission from Kalita et al⁴⁴ Copyright © 2003, American Medical Association. All rights reserved.

Eastern equine encephalitis. FLAIR image illustrates basal ganglia involvement typical in this disease and involvement of the thalami, insula, and more peripheral cortex. Reprinted with kind permission from Springer Science and Business Media from Lury and Castillo.⁵¹

Dengue. DWI (A) shows increased signal in the genu and splenium of the corpus callosum and posterior limbs of the internal capsules in a patient with dengue encephalopathy. Areas of edema or restricted diffusion in dengue encephalopathy are nonspecific and variable. Noncontrast CT of a different patient (B), with dengue shock syndrome, shows subdural and parenchymal hemorrhage. Intracranial hemorrhage is uncommon in dengue, even in those with systemic and cutaneous hemorrhagic complications. Reprinted from Bhoi et al⁵⁵ with permission from Elsevier.