Presentation
Infective endocarditis treated by antibiotic therapy. Status post mitral valve replacement. Recently neurologic symptoms.
Patient Data
Few, hard to depict, small hypodense lesions located in the left caudate head and both cerebellar cortex are seen.
In the right occipito–parietal region a parenchymal hemorrhage is seen measuring in cross-sectional dimension 44 x 33 mm; lesion is associated with moderate edema around in concordance with probable hemorrhagic infarct.
In the right cerebellar hemisphere, hypodense areas in the cortical and subcortical layers are seen in keeping with is ischemic changes.
Moreover, after contrast administration, several smaller roundish lesions are detectable in the following locations: a subcortical layer of the anterior aspect of the right frontal lobe, left caudate head, a cortical layer of the left cerebellar hemisphere. The lesion in the left caudate head and in the right frontal lobe has ring enhancement pattern - abscess formation suspected.
Supratentorial surface sulci on the right are effaced due to mass effect of parenchymal hemorrhage. Right lateral ventricle is slightly compressed.
Case Discussion
Considering the clinical history of infective endocarditis and significant interval worsening of CT appearance in differential septic-embolic encephalitis is the favored diagnosis.
Vascular imaging to identify any mycotic aneurysms is critical.
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