Cerebellar abscess

Case contributed by Assoc Prof Frank Gaillard

Presentation

Headaches and ataxia.

Patient Data

Age: Elderly
Gender: Male

MRI brain

MRI

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. 

Case Discussion

The patient went on to have the abscess drained in theater later that day. 

Microbiology

SPECIMEN: Specimen type: Pus, total specimen volume:  5 ml

MICROSCOPY: GRAM STAIN

  • Leukocytes                    +++
  • Gram-positive cocci           +++
  • Gram-positive bacilli         +++
  • Gram-negative bacilli         ++

CULTURE

  • +++ alpha hemolytic streptococci

Discussion

This case demonstrates typical features of an abscess. Note that the although morphology is helpful, cystic metastases or cystic primary high grades tumors (GBM) can all look very similar. The most helpful sequence, in this case, is diffusion-weighted imaging. 

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