Cerebral abscess - shaggy borders
Adult patient presenting with a seizure.
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MRI of the brain demonstrates, within the left occipital lobe, a rounded region demonstrating central high T2, low T1 signal is demonstrated. It is bounded by a region of relative low signal on T2 and surrounded by extensive vasogenic oedema.
Diffusion weighted imaging demonstrates marked restriction, and the periphery of the lesion demonstrated bright ring enhancement with somewhat shaggy borders.
MRS (performed in the lesion) has a noisy base line but an inverted lactate peak is none the less visible, as are reduced choline, creatine, and NAA peaks.
Findings are consistent with a cerebral abscess.
This patient went on to have a craniotomy and drainage which confirmed the diagnosis.
These features are characteristic of a pyogenic abscess and the diagnosis can be made with confidence.