Presentation
A 4-day history of rapidly progressive headache and aphasia.
Patient Data
Left temporopareital subcortical fairly defined irregular space-occupying lesion is seen eliciting lo signal on T WI, high signal on T2, FLAIR WI, diffusion restriction with well-defined hypointsense margins showing blooming effect and marginal post-contrast enhancement. The lesion measures 2.2x 2.4x 3.0cm at its max TS, AP, and CC dimensions. It’s surrounded by vasogenic edema signal and exerts a mass effect in the form of effacement of the overlying cortical sulci.
MRS show mildly elevate choline peak and markedly elevated Lipid/Lactate peak.
Radiological findings are impressive of brain abscess.
Laboratory workup showed elevated inflammatory markers (ESR and CRP). CT scan of the abdomen and pelvis to detect an inflammatory process spreading to the brain.
Normal CT scan of the chest, abdomen, and pelvis. No inflammatory processes were detected.
The patient underwent surgical drainage and biopsy. Pathology revealed a florid acute inflammatory process with abscess formation.
Culture and sensitivity revealed Enterococcus ssp bacteria.
Images illustrate the typical appearance of cerebral abscess with typical diffusion restriction and marginal contrast enhancement.
Case Discussion
This case was challenging because the patient was afebrile and was not preceded by clear infectious symptoms. Though the lesion showed typical diffusion restriction and marginal post-contrast enhancement, it was debatable for the treating surgeon to discriminate between an abscess and or a tumor because of the solid appearance of the lesion on T2 WI and the lack of bacterial infection on laboratory workup. Secondary to the rapid deterioration of the patient's condition, the patient was rapidly taken to surgery. Aspiration of the pus and biopsy revealed an abscess with Enteroccocus ssp bacteria.
Unable to process the form. Check for errors and try again.