The central nervous system (CNS) undergoes constant immune surveillance enabled via regionally specialized mechanisms. These include selectively permissive barriers and modifications to interlinked innate and adaptive immune systems that detect and remove an inciting trigger. The end-points of brain injury and edema from these triggers are varied but often follow recognizable patterns due to shared underlying immune drivers. Imaging provides insights to understanding these patterns that often arise from unique interplays of infection, inflammation and genetics. In this presentation, we will review the current updates in our understanding of these intersections using examples of cases from our practice showing that that infection and inflammation follow diverse yet convergent mechanisms that can challenge the CNS in children.