Infected bone flap post craniotomy
Fever, headache, reduced conscious state and right hemiplegia about 6 weeks post craniotomy for meningioma removal
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Rim enhancing mass with marked surrounding vasogenic oedema immediately deep to a craniotomy defect showing 2 sites of bone erosion involving the inner table indicating osteomyelitis. Note gas in the fluid collection. This gas is very abnormal ~6 weeks post surgery, i.e. not due to the surgical procedure and indicates gas-forming organisms.
Appearances in the brain are typical of cerebral abscess but note the broad base at the level of the craniotomy with bone erosion. On that basis the bone flap is infected and the underlying brain secondarily involved with marked surrounding vasogenic oedema that is also typical for cerebral abscess.