Brain abscess

Case contributed by Dr Libya Saleh


Seizures and DCL.

Patient Data

Age: 2 years
Gender: Female

Left parieto-occipital and left insular intra-axial multiple confluent variable sized ring-enhancing lesions, eliciting low signal in T1 and high in T2/FLAIR with restricted diffusion. Vasogenic edema is also seen exerting mass effect in the form of effacement of the adjacent cortical sulci and compression of the ipsilateral lateral ventricle with no midline shift. picture of an inflammatory process (abscesses). 

Additionally the confluence of dural venous sinuses, left transverse and sigmoid sinuses, as well as the proximal left internal jugular vein, are seen distended with loss of signal void pattern and negative enhancement in the post contrast T1, a picture of dural venous sinus thrombosis.

Bilateral otomastoiditis are also noted more on the left side.

Case Discussion

Brain abscess is an inflammatory process in the form of focal areas of necrosis 

the best imaging modality in case of brain abscess is MRI with contrast and DWI as the lesion shows the following signal,

T1: low Signal intensity 

T2/FLAIR: high Signal intensity

T1+c ring enhancement with central restricted diffusion 

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