Presentation
Increasing ataxia and headaches. Febrile illness 1 week prior.
Patient Data
Age: 3 years
Gender: Male
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Axial T2

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 edema and results in mass effect and compression of the 4th ventricle. A moderate degree of hydrocephalus is present (note the transependymal edema).
Case Discussion
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.