Headaches and ataxia.
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Selected MRI images demonstrate a left cerebellar hemisphere lesion, which has high T2 signal centrally, and a thin relatively regular rim of contrast enhancement peripherally. Centrally restricted diffusion is present, confirmed on ADC (not shown). Note the presence of dilatation of the occipital horns, consistent with hydrocephalus.
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The patient went on to have the abscess drained in theatre later that day.
SPECIMEN : Specimen Type : Pus, total specimen volume: 5 ml
MICROSCOPY : GRAM STAIN
- Leucocytes +++
- Gram positive cocci +++
- Gram positive bacilli +++
- Gram negative bacilli ++
- +++ alpha haemolytic streptococci
This case demonstrates typical features of an abscess. Note that the although morphology is helpful, cystic metastases or cystic primary high grades tumours (GBM) can all look very similar. The most helpful sequence in this case is diffusion weighted imaging.