Cerebral abscess

Case contributed by Assoc Prof Frank Gaillard

Presentation

New onset partial seizure.

Patient Data

Age: 35 years
Gender: Male

Right frontal lobe ring enhancing lesion, centered at the grey-white junction, measuring 28 mm in maximal diameter and with marked surrounding vasogenic edema and mass effect as described on the earlier CT.

The lesion has a well-defined T2 hypointense margin and demonstrates marked central diffusion restriction. A prominent lipid and lactate peak is noted on spectroscopy (not shown). Thin peripheral hypointensity seen on echoplanar sequence is complete and smooth. 

Right maxillary sinus mucous retention cysts are noted as described on the previous CT. No evidence of sinusitis or mastoiditis is identified. Cavum septum pellucidum and vergae.

Conclusion:

The marked diffusion restriction and elevated lactate on MRS are most consistent with cerebral abscess.

Case Discussion

The patient went on to have a craniotomy and drainage of pus containing cavity. 

Microbiology

Specimen Type : Aspirate, Right Frontal Lesion

  • MICROSCOPY (Gram stain)
    • Leukocytes +++
    • Gram positive cocci +++
  • CULTURE
    • Streptococcus anginosus group (milleri group) +++

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