Presentation
Altered level of consciousness. Known to have colon neuro-endocrine tumor, and left eye mass on fundoscopic examination.
Patient Data
Multiple bilateral cerebral and cerebellar small round signal abnormalities depicting high DWI signal. ADC map is not available.
A tiny signal is also seen involving the left side of the medulla oblongata.
The above findings are not associated with significant perifocal edema.
After the administration of gadolinium contrast, the above lesions show ring enhancement.
Tiny signal abnormality is seen involving the right eye globe fundus, which shows faint enhancement possibly due to metastases.
Impression:
- Cerebral and cerebellar lesions favor septic emboli with microabscess given the fact they are not associated with significant perifocal edema and less likely recent emboli infarcts or metastases.
- Tiny signal abnormality is seen in the right eye globe fundus, which shows faint enhancement, possibly due to metastasis.
Case Discussion
This gentleman known to have a colonic neuroendocrine tumor, presenting with altered level of consciousness, upon initial evaluation with Brain MRI and contrast administration shows multiple ring-enhancing lesions involving the cerebrum and cerebellar regions without significant perifocal edema.
However, given the clinical context of the patients' clinical history, a biopsy was performed for a definitive diagnosis. The histopathology report confirmed these were abscesses.
Unfortunately, ADC map images are not available. As our institutional protocol during that time DWI images were only done and hyperintensities were considered diffusion restriction without correlating with ADC map images.
The sagittal images on T1C+ show wrap-around artifact due to the small field of view during the acquisition of images.
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