Emergent CNS Infections, Inflammations, and Tumors

Abstract

Patients with central nervous system (CNS) neoplasms are potentially subjected to develop many neurologic complications of their disease or its treatment. The central and peripheral nervous systems can be also significantly affected by systemic malignancies. These neuro-oncologic conditions are common and represent a significant cause of morbidity and hospital admission, not rarely at risk for serious, timely, and life-threatening events. Early diagnosis and timely treatment are required to ensure the best possible outcome, prolonging survival, and improving the quality of life; appropriate management may preserve neurologic function and may be life-saving. Neuroimaging evaluation represents a critical point in management of these patients, being helpful and often essential to define the diagnosis. Noncontrast head computed tomography (CT) is often the preferred imaging modality for the first examination of acute patients, due to speed and availability. Magnetic resonance imaging (MRI) is superior in identifying lesions and related features, characterizing them, and detecting the associated complications in order to obtain a more complete diagnosis. Central nervous system infections still have a great impact in terms of severity, affecting all age groups; they may represent a real medical emergency because of the consequent complications and fatal outcome if not diagnosed and treated promptly. The role of diagnostic imaging is fundamental, because CT and MR imaging have had a great impact on the diagnosis and management of CNS infections together with the physical examination and laboratory investigations, especially in identifying and narrowing the differential diagnosis and monitoring the therapeutic response. The relevant literature concerning all of these topics is summarized in this chapter.