Study of Clinicodemographic Profile in Children with Acute CNS Infection and Its Correlation with Neuroimaging

Introduction: Infection of the central nervous system (CNS) is the most common cause of fever that is associated with signs and symptoms of CNS disease in children. Viral infections of the CNS are much more common than bacterial infections, which, in turn, are more common than fungal and parasitic infections. Radiology and pathology are inseparable at the time of understanding the phenomenon causing nervous system infections. There are a wide range of neuroimaging findings in central nervous system (CNS) infections, often with considerable overlap, which makes determination of a specific diagnosis difficult. The present study aims to study the utility of neuroimaging in diagnosis of acute CNS infection and the neuroimaging patterns found in different CNS infection. Aim: 1. To study the utility of neuroimaging in CNS infection in paediatric age group. 2. To study the pattern of neuroimaging in children in CNS infection. 3. To study the socio demographic and clinical profile of CNS infection in children. Method: This is prospective observational study in children (1month – 14 years old) who are presented with CNS infection. Result: Total 116 cases of less than 14 years old children were suspected to have CNS infection in study period at a tertiary care center. It was observed that acute CNS infection was more prevalent in 1 month -1 year age group with (27.58 %), followed by 5 – 8 year (24.13%),1- 8 year (20.68%) and 3-5 year (5.17%). In this study neuroimaging was done in all suspected cases (116) of CNS infection in which 55.91(48.2%) patients had normal neuroimaging study and 60(51.7%) had abnormal neuroimaging study. Among the cases with abnormal neuroimaging 6 (10%) showed pyogenic meningitis, tubercular meningitis was present in 14 (23.23%) patients, tuberculoma in 8 (13.13%), TBM + tuberculoma in 6 (10%), viral meningitis in 8 (13.3%), HSE in 2 (3.3%), COVID encephalitis in 2(3.3%), ADEM in 8 (13.3%) while 4 patients (6.66%) were found to have brain abscess. Correlation between final diagnosis and neuroimaging was 100% in ADEM, Brain abscess, tuberculoma, TB spine, HSV followed by TBM 77.77% and followed by pyogenic meningitis (27.27%) and viral encephalitis (26.66%). Clinically diagnosed acute CNS infection was confirmed in 51.72% (60 case) and was wrong in 48.27 %( 56 case). Conclusion: CNS infections were more common in less than 5 years age. Around half of the patients had abnormal neuroimaging finding. Neuroimaging studies are helpful to monitor the complications such as subdural effusion, hydrocephalus, infarction etc. It was found that neuro-imaging was accurate in early diagnosis and categorization of CNS infections with high sensitivity in CNS tuberculosis.