Cerebral abscess with ring enhancement

Case contributed by Mohammad Farghali Ali Tosson , 27 Feb 2017
Diagnosis probable
Changed by Bruno Di Muzio, 3 Mar 2017

Updates to Study Attributes

Findings was changed:

AWell defined lefthigh parietal thick walled cystic lesionshowing the following criteria:

central high intensity in T2WI and FLAIR while low signal thin rim abscess capsule

Showing; restriction of diffusion of its central contentwith low ADC value while high signal capsule

Showing peripheral; peripheral enhancement in post contrast study

Associated; associated with perilesional vasogenic edemathat facilitated in DWI

Right temproparietalwhite matter vasogenic edema exhibiting hypointense signal in T1Wi and hyperintense signal in T2WI with no definite enhancement and no restriction in DWI ..suggestivesuggestive of multiple areas of cerebritis

Updates to Quizquestion Attributes

Question was changed:
whatWhat are the differential for peripheral or ring enhancing cerebral lesions?
Answer was changed:
The differential for peripheral or ring enhancing cerebral lesions includes:cerebral abscess, tuberculoma, neurocysticercosis, metastasis, glioblastoma, subacute infarct / haemorrhage / contusion, demyelination (incomplete ring), tumefactive demyelinating lesion (incomplete ring), radiation necrosis, postoperative change and lymphoma - in immunocompromised patient / A helpful mnemonic is MAGIC DR.

Updates to Quizquestion Attributes

Question was changed:
whatWhat is the role of DWI in cerebral abscess diagnosis?
Answer was changed:
Bacterial abscesses reliably demonstrate restricted diffusion, and DWI has proved useful in distinguishing abscesses from necrotic tumors, resolving hematomashaematomas, and other fluid-filled cavities.

Updates to Quizquestion Attributes

Question was changed:
How to differentiate between the cytotoxic and vasogenic brain edema/?
Answer was changed:
The vasogenic edema do not show restricted diffusion while the cytotoxic cerebral oedema shows diffusion restriction.

Updates to Quizquestion Attributes

Updates to Case Attributes

Body was changed:

The diffusion has an important role in the diagnosis of cerebral abscess and to differentiate it from the other ring enhancing lesions as metastases and gliomas.

The abscess center showing diffusion restriction while its wall is facilitated in DWI.

  • -<p>The diffusion has an important role in the diagnosis of cerebral abscess and to differentiate it from the other ring enhancing lesions as metastases and gliomas</p><p>The abscess center showing diffusion restriction while its wall is facilitated in DWI</p><p> </p>
  • +<p>The diffusion has an important role in the diagnosis of cerebral abscess and to differentiate it from the other ring enhancing lesions as metastases and gliomas.</p><p>The abscess center showing diffusion restriction while its wall is facilitated in DWI.</p><p> </p>

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