Presentation
Headache and neck stiffness. SAH?
Patient Data
4cm rim enhancing cystic lesion in the left cerebellar hemisphere. Moderate perilesional edema.
The 4th ventricle is effaced and displaced to the right. Prominence of the temporal horns.
The venous sinuses opacify normally. Normally aerated mastoid air cells.
4.1 x 2.8 cm rim enhancing lesion in the posteromedial aspect of the left cerebellar hemisphere. This extends towards the dural surface which is thickened and enhancing, with a tiny tract extending from the inferior wall of the abscess towards the dura and into the bony ostium. Avid diffusion restriction within the lesion.
Moderate amount of perilesional cytotoxic edema. The mass and abscess combine to displace and efface the fourth ventricle.
No hydrocephalus.
No other enhancing lesions.
Small amount of periventricular small vessel ischemic change.
Case Discussion
The imaging findings are of a solitary ring enhancing brain lesion.
The cross sectional imaging findings are consistent with a cerebral abscess, in particular, observe the intensely avid intralesional diffusion restriction. The clinical history was entirely consistent with the findings. The patient was referred to a neurosurgical center for management.