Purpose or Case Report: The clinical presentation of neonatal CNS infections is often non-specific, requiring neuroimaging to narrow the differential diagnoses for prompt treatment and improved outcomes. Congenital infections include TORCH infections (Toxoplasmosis, Others (HIV, parvovirus, syphilis, and others), Rubella, Cytomegalovirus, Herpes simplex). Perinatal and postnatal CNS infections are related to other less common pathogens such as E. coli, Enterobacter, Candida, Parechovirus, and COVID-19 infections.

The imaging pattern of neonatal CNS infections varies depending on the patient’s age and stage of development at the time of exposure. The presentations of neonatal CNS infections include meningitis, encephalitis, leukoencephalopathy and vasculitis with and without complications.

Imaging aids in narrowing the differential diagnosis in complex cases and allows for the recognition of complications. We describe the imaging findings of neonatal CNS infections, ranging from common TORCH infections to rare pathogens.

We provide an educational case-based review of the imaging findings of various neonatal CNS infections while discussing their complications such as arterial stroke, venous thrombosis, hydrocephalus, abscess, and subdural empyema. We will explain the various imaging modalities used in the approach to neonatal infection while highlighting the precautions and need for administering IV contrast.

We aim to establish a systematic approach to the imaging workup of neonatal CNS infections to narrow the correct diagnosis, thereby expediting appropriate subspecialty referral and treatment.
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