An 81-year-old man was presenting with mild neck stiffness, headache and fever. Blood tests showed leukocytosis and high C-reactive protein. Low glucose levels and elevated granulocytes and proteins were found in cerebrospinal fluid (CSF). Gram stain and culture of CSF were negative. 
The patient did not have relevant previous medical history. Serologies for HIV-1 and HIV-2 were negative.

Contrast-enhanced brain CT and T1-weighted MRI taken after gadolinium injection.
What are the abnormalities seen in these image?


ANSWER

Contrast-enhanced brain CT showed a low density mass in the frontal lobe with peripheral oedema and a thin enhancing capsule after contrast injection. Hyperdense material on the right occipital horn was also seen, with no significant ependymal enhancement.
T1-weighted images after gadolinium injection showed ring-enhancement related to the capsule and ruptured into lateral ventricle associated to a mild ependymal enhancement.

Answer - Ventriculitis as a complication of a brain abscess


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13 comments

  1. Anonymous Says:
  2. BRAIN TBC.

     
  3. Dr. Jay Says:
  4. Looks for like an abcess than a ghon complex like the previous fellow mentioned. There is a shift of cerebral contents to the left which is marked as is described by the lateral ventricles in relation to the midline.

     
  5. Dr. Jay Says:
  6. Looks more like an abscess than a ghon complex..

     
  7. Danilo Says:
  8. Brain abcess

     
  9. Looks like a ruptured abscess to me - in the first of the MRI images it looks like it's ruptured into the ventricle, which would explain the CSF findings.

     
  10. high C reactive protein indicator for inflammation focal mass in anterior part of brain with shift of midline to left ,focal mass rounded anechoic with echogenic walls surrounded by hypoechoic texture differential consideration is brain abscess,

     
  11. mohammed Says:
  12. this is typical ring enhancement charectrestic for toxoplasmosis of the brain

     
  13. Anonymous Says:
  14. Brain abcess

     
  15. Anonymous Says:
  16. a circumscribed hypointense area sorrounded by a hyperintense rim suggestive of ring enhancement in the Right frontal lobe,with sorrounding irregular hypointense area suggestive of reactionary edema, presence of midline shift and elevated inflamatory markers and other given criteria suggests likely diagnosis of Brain Abscess with mass effect

     
  17. Anonymous Says:
  18. Brain abcess maybe form toxo or more likely from rich focus if patient with TBC history, no thorax photo taken?
    Mild midline shifting

     
  19. abcess or tuberculoma,in rt frontoparietal lobe with mid-line shift to opposite side n regional cerebraledema........invoving lateral venticle n head of caudate nucleus......leucocytosis low glucose crp raised n high protein suggest ceberal tuberculoma.

     
  20. madeeha Says:
  21. abcess or tuberculoma,in rt frontoparietal lobe with mid-line shift to opposite side n regional cerebraledema........invoving lateral venticle n head of caudate nucleus......leucocytosis low glucose crp raised n high protein suggest ceberal tuberculoma.
    tuberculous meningitis

     
  22. Anonymous Says:
  23. dx all these and Neurocysticercosis

     

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