<I>Diagnosis of Brainstem Abscess in the Cerebritis Stage by Magnetic Resonance Imaging</I>

Abstract

A 52-year-old male presented with a brainstem abscess manifesting as high fever, diplopia, and left hemiparesis. Magnetic resonance (MR) imaging with gadolinium diethylenetriamine pentaacetic acidshowed the lesion as a ring-like enhanced mass consisting of a necrotic center with surrounding edema, whereas postcontrast computed tomography revealed no such confirmatory findings. He was treated with antibiotics as the lesion had been detected in the acute cerebritis stage. Serial MR images showed that the lesion decreased remarkably in size. MR imaging can detect brain abscess in the earliest in flammatory stage.

Unusual intracranial suppuration: illustrative cases

“…42 Prevalent symptoms include fever, headache, focal neurological deficit, pain localized to the side of the abscess, seizures, nausea, mental status changes, vomiting, and nuchal rigidity. 1,2,14,17,20,39,40,42 Early detection and diagnosis of BA through CT or MRI allow better localization of the abscess. 42 As with SDE, it is considered extremely dangerous to perform lumbar puncture to obtain cerebrospinal fluid cultures in patients with BA unless clinicians strongly suspect concurrent meningitis.…”

“…CT of the brain is considered the main imaging modality for detection and diagnosis of ICS; in cases where an accurate diagnosis cannot be achieved, magnetic resonance imaging (MRI) is used. 2,7,17,[20][21][22] Although SDE and BA are well-known disease entities of ICS, sterile site ICS is uncommonly seen. Therefore, the authors of this study report 2 cases of sterile ICS, a sterile SDE and a aseptic occipital BA that were treated in the Neurosurgery Unit at Rwanda Military Hospital.…”

Gas-Forming Intracerebral Abscess with Pediatric Parafalcine Subdural Empyema with Review of Literature

“…11 MRI is more sensitive than CT scan as it can detect abscess in the earliest stages besides providing better anatomic details, multiple imaging planes, lack of bony artifacts, especially in posterior fossa, and increased sensitivity for follow-up examination. 13,14 Other improved radio diagnostic noninvasive techniques available to detect brain abscess are magnetic resonance spectroscopy and diffusion-weighted imaging which also helps to differentiate abscess from necrotic or cystic tumors. 15,16 Pathogenesis of Brain abscess…”

Differential Diagnosis of T2 Hyperintense Brainstem Lesions: Part 1. Focal Lesions

“…74 The characteristic imaging finding is the presence of a lesion displaying contrast uptake in the form of a ring with surrounding vasogenic edema. 74 On T2-weighted sequences the capsule is hypo-or isointense 74,78 with a markedly hyperintense central portion, 74 typically showing restricted diffusion. 74 This diffusion behavior is probably the result of the high viscosity of coagulative necrosis, the hypercellularity of the pus, and the binding of water molecules on the surfaces of the bacterial walls.…”