Cereberitis with developing brain abscess

Case contributed by Dr Mohammad A. ElBeialy

Presentation

Cirrhotic patient with fever and disturbed level of consciousness.

Patient Data

Age: 54 years
Gender: Female
Modality: MRI

  • A large about 7.5 x 5.7 X 6 cm (along its maximum antero-posterior, transverse and cranio- caudal dimensions respectively) ill-defined and left fronto-parietal and temporal space occupying lesion is seen demonstrating heterogeneously hypeintense T2 and FLAIR signals and heterogeneously hypointense T1 signal as well as restricted diffusion with hyperintense DWI and low ADC signal with faint marginal post contrast enhancement. The lesion shows areas of cystic degeneration with CSF signal along its anterior and superior aspects. The lesion is associated with mild amount of perifocal brain edema and exerting mass effect in the form of effacement of the ipsilateral left lateral and 3rd ventricles with mild supratentorial hydrocephalus and transependymal retrograde CSF permeation with periventricular T2 and FLAIR hyperintensity as well as contralateral midline shift. The lesion is obliterating the left perimesencephalic cistern with compression of the left crus cerebrus as well as partial effacement of the related left aspect of the quadrigeminal cistern. The left middle cerebral artery is seen splayed anteriorly and superiorly around the lesion; yet with preserved signal void.
  • No extra-axial collection. No cerebello-pontine angle masses. Normal posterior fossa structures. Patent (signal void) arteries sharing in the circle of Willis’ as well as the major dural venous sinuses. Normal sellar region.  

Case Discussion

A left fronto-parietal and temporal mass lesion with significant mass effect and supratentorial hydrocephalus as described; consistent with cerebritis and brain abscess.

The differential diagnosis of a brain tumor was unlikely in such a clinical setting with restricted diffusion on MRI. CT of the brain was done 10 days before and was unremarkable.

The patient died a few days after the examination.  

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Case Information

rID: 43065
Case created: 21st Feb 2016
Last edited: 12th Jul 2016
Inclusion in quiz mode: Included

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