Cerebral abscess with ventriculitis
This patient underwent surgery to his left ear two weeks ago. He recently developed fits and a disturbed conscious level.
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Conventional MRI of the brain demonstrates diffuse abnormal signal and vasogenic edema involving the left temporal lobe and abnormally dilated supratentorial ventricular system.
High T1 signal of the left occipital lobe cortex representing areas of cortical laminar necrosis as well as the high signal of the left occipital horn well demonstrated on axial T1 and axial FLAIR (ventricular debris). Associated transependymal oedema.
DWI and ADC show area of restricted diffusion within the left temporal lobe and the left occipital horn content.
Post-contrast images demonstrate a left temporal lesion with ring enhancement pattern as well as ependymal enhancement of the left lateral ventricular wall.
Signs of ventriculitis include:
- ventricular debris, the debris is hyperintense to CSF on T1-weighted images and DWI and hypointense to CSF on T2-weighted images and ADC
- the periventricular hyperintense signal of trans ependymal oedema
- ventricular wall enhancement. Septations of the ventricle usually encountered later on