Cerebral abscess - shaggy borders

Case contributed by Assoc Prof Frank Gaillard

Presentation

Adult patient presenting with a seizure.

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 edema. 

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.

Case Discussion

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. 

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