Otogenic cerebral abscess

Case contributed by Dr Erik Ranschaert

Presentation

Diplopia and headache. No fever. Had recent surgery of the left middle ear.

Patient Data

Age: 15 years
Gender: Female

MRI Brain

MRI

A sharply demarcated oval mass in left temporal and parietal lobes, with hypo-intense content and slight hyperintense rim, with considerable mass effect on the brainstem. On FLAIR it is of mixed content, thin hypointense rim, surrounding edema and mass-effect, hyperintense signal in left petrous bone. Following administration of contrast, there is rim enhancement of the lesion and continuity with enhancing area in left middle ear. The content demonstrates profound diffusion restriction. 

Case Discussion

Features are consistent with an otogenic cerebral abscess after recent surgery of the left middle ear. A dual rim sign is evident on FLAIR imaging. 

Case courtesy of Dr. R. Noordveld

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