Last Updated: October 1, 2018
- Most commonly caused by Candida albicans, though glabrata and parasilosis are also common
- CNS infection almost always caused by hematogenous spread with disseminated systemic infection
- Small, round to oval, thin-walled, yeast like fungi that reproduce by budding or fusion
- Pseudohyphae predominate, but occasionally true hyphae are also seen.
- Variable but generally include insidious onset lethargy and AMS
Age and Gender
- No predilection
- Mortality rates are high
- Treatment for bacterial sepsis, IV hyperalimentation, HIV with low CD4, immunosuppression, hematologic malignancy, and premature birth
- Most common findings are numerous microabscesses (<3mm) occurring at the corticomedullary junction, basal ganglia, or cerebellum
- Often demonstrate enhancement and less often demonstrate hemorrhage or infarction
- Meningitis is a less common presentation
- Usually normal
- hyper-, iso- or hypointense
- Hypointensity seen in the setting of hemorrhage
- Small ring-enhancing lesions
- Standard protocol MR (including DWI) with intravenous contrast
- The most common presentation of numerous microabscesses is most difficult to distinguish from metastatic disease and other fungal processes. Clinical history with appropriate risk factors often provide the most help when narrowing the differential.
For more information, please see the corresponding chapter in Radiopaedia.
Contributor: Sean Dodson, MD
Lai PH, et al. Disseminated Milary Cerebral Candidiasis. AJNR. 1997; 18:1303-06.
Lin DJ, et al. Neurocandidiasis: A Case Report and Consideration of the Causes of Restricted Diffusion. J Raiol Case Rep. 2013; 7(5):1-5.
Rabelo NN, et al. Differential Diagnosis between Neoplastic and Non-Neoplastic Brain Lesions in Radiology. Arq Bras Neurocir. 2016. Doi: 10.1055/s-0035-1570362.
Shih RY, et al. Bacterial, Fungal, and Parasitic Infections of the Central Nervous System: Radiologic-Pathologic Correlation and Historical Perspectives: From the Radiologic Pathology Archives. Radiographics. 2015; 35(4):1141-69.
Starkey J, et al. MRI of CNS Fungal Infections: Review of Aspergillosis to Histoplasmosis and Everything in Between. Clin Neuroradiol. 2014; 24(3):217-30.
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