Cerebral abscess

Case contributed by A.Prof Frank Gaillard

Presentation

Headache.

Patient Data

Age: 30 years
Gender: Male
Modality: CT

A circumscribed hypodensity in the left frontal lobe, with a daughter lesion inferomedial is noted. There are multiple locules of gas within the collection. 

Extensive sinus opacification, particularly of the left frontal sinus, are noted. 

Conclusion: 

Cerebral abscess secondary to frontal sinusitis. 

Case Discussion

Patient went on to have surgery.

Histology

MICROSCOPIC DESCRIPTION:

Sections of brain tissue show a central well circumscribed cavity containing inflammatory necrotic material with abundant neutrophils and foamy macrophages present. The adjacent brain parenchyma contains prominent capillary sized blood vessels and reactive gliosis. No parasites are seen. There is no evidence of malignancy. Special stains (PAS, Grocott, Gram and ZN) are negative for fungal and bacterial micro-organisms.

Microbiology

DIRECT EXAMINATION: Calcofluor White Stain: No fungal elements detected

GRAM STAIN: Leucocytes +, Gram negative bacilli +++, Gram positive cocci ++

CULTURE: 

  1. Streptococcus anginosus group (milleri group) ++ 
  2. Prevotella oris ++

SENSITIVITIES 1, Ceftriaxone S, Penicillin S

FINAL DIAGNOSIS: cerebral abscess

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Case Information

rID: 42932
Case created: 15th Feb 2016
Last edited: 13th Mar 2017
Inclusion in quiz mode: Included

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