Pediatric non-congenital central nervous system infections: role of imaging in the emergency department

Neurological emergencies in pediatric patients, including central nervous system infections like meningitis and encephalitis, account for significant morbidity and mortality. Neuroimaging plays an important role in the management of these infections, especially when children present with non-specific symptoms such as fever, seizures, or altered consciousness. While computed tomography scans are typically the initial imaging step, magnetic resonance imaging is preferred for its superior detail and lack of ionizing radiation. Radiologists play a crucial role in guiding clinicians to select the appropriate imaging modality based on clinical presentation, patient age, and available technology. Optimizing techniques for these studies may help to give an overview of imaging protocols and an optimal diagnostic algorithm for these patients. In this article, we delineate the prevalent radiological manifestations associated with the primary etiological agents of central nervous system infections, encompassing bacteria, fungi, viruses, and parasites. Furthermore, we share our clinical experience with particular radiologic findings in select pathologies, underscoring the critical importance of evaluating these non-congenital infections within the context of emergency medical care.