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Cerebral abscess

Case contributed by Ian Bickle
Diagnosis certain

Presentation

Young male patient with headache and pyrexia. No history of immunosuppressive disease.

Patient Data

Age: 35 years
Gender: Male
ct

Enhancing right basal ganglia lesion, with perilesional odema and ventricular displacement.

The lesion is multiloculated.

Tiny focus of enhancement with surrounding edema in the left pre-central gyrus close to the vertex.

mri

Multifocal thick walled enhancing lesion centered on the right lentiform nucleus, with avid ring enhancement and central diffusion restriction.

Perilesional edema, which in conjunction with the lesion itself is causing effacement and displacement of the frontal horn of the right lateral and third ventricles.

Tiny focus of enhancement in the left pre-central gyrus close to the vertex.

Image guided surgery

Photo

Image guided surgical navigation performed - aspiration of the cerebral abscess in progress  - the syringe has a significant volume of pus within.

( Images courtesy of Dr Selvam, Neurosurgeon, RIPAS Hospital, Brunei )

Case Discussion

Ring enhancing cerebral lesions can result from various etiologies. One cause is a cerebral abscess, which has characteristic imaging appearances (in most cases) on MRI with restricted diffusion on DWI/ADC maps, as well as spectroscopy patterns.

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