Increasing ataxia and headaches. Febrile illness 1 week prior.
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Selected images from an MRI of the brain demonstrates a large peripherally enhancing mass in the right cerebellar hemisphere. It demonstrates prominent central restricted diffusion. It is surrounded by oedema and results in mass effect and compression of the 4th ventricle. A moderate degree of hydrocephalus is present (note the transependymal oedema).
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This patient went on to have a craniotomy and aspiration of the content of the lesion.
Gram stain: ++++ Gram positive cocci in chains and pairs, confirmed to be Strep pneumoniae.