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 of the lesion(TE = 144 ) has a noisy baseline 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.