What neuroimaging findings suggest bacterial meningitis?

Updated: Jul 16, 2019
  • Author: Rodrigo Hasbun, MD, MPH; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

In patients with suspected bacterial meningitis, blood cultures should be obtained and treatment initiated before imaging studies and LP. Neuroimaging may yield normal results or demonstrate small ventricles, effacement of sulci, and contrast enhancement over convexities (see the images below). Late findings include venous infarction and communicating hydrocephalus. Brain abscess, sinus or mastoid infection, skull fracture, and congenital anomalies must be ruled out. (See Imaging in Bacterial Meningitis.)

Acute bacterial meningitis. This axial nonenhanced Acute bacterial meningitis. This axial nonenhanced computed tomography scan shows mild ventriculomegaly and sulcal effacement.
Acute bacterial meningitis. This axial T2-weighted Acute bacterial meningitis. This axial T2-weighted magnetic resonance image shows only mild ventriculomegaly.
Acute bacterial meningitis. This contrast-enhanced Acute bacterial meningitis. This contrast-enhanced, axial T1-weighted magnetic resonance image shows leptomeningeal enhancement (arrows).

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