Infections of the CNS are very rare and generally manifest as single or multiple encapsulated brain abscesses that appear as ring-enhancing lesions with thick wall that may be irregular or nodular on CT with intravenous contrast material and are indistinguishable from those caused by other organisms (6). Rarely, solid nodular or mass lesions termed actinomycetomas or actinomycotic granulomas are found. Headache and focal neurological signs are the most common finding. Most actinomycotic infections of the CNS are thought to be seeded hematogenously from a distant primary site; however, direct extension of cervicofacial disease is well recognized. Sinus formation is not a characteristic of CNS disease. The rare meningitis caused by Actinomyces is chronic and basilar in location, and the pleocytosis usually is lymphocytic. Thus, it may be misdiagnosed as tuberculous meningitis.
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