MR imaging of brain abscesses

Haimes, Alison B.; Zimmerman, Robert D.; Morgello, Susan; Weingarten, Karen; Becker, Richard D.; Jennis, Richard; Deck, Michael D. F.

doi:10.2214/ajr.152.5.1073

Cited by 238 publications

(153 citation statements)

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“…These biochemical factors include paramagnetic compounds 18 such as iron and manganese ions, and free radicals produced by macrophages. 19 Lipid accumulation also appears hyperintense on T1W MRI. 20 Recently, neuropathological and neurochemical changes at late perfusion periods after brief brain ischemia have drawn attention in experimental studies.…”

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confidence: 99%

Delayed Ischemic Hyperintensity on T1-Weighted MRI in the Caudoputamen and Cerebral Cortex of Humans After Spectacular Shrinking Deficit

Fujioka

Taoka

Hiramatsu

et al. 1999

Stroke

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Background and Purpose-Transient internal carotid artery (ICA)-middle cerebral artery (MCA) occlusion caused by cardiogenic embolus can lead to spectacular shrinking deficit (SSD): sudden hemispheric stroke syndrome followed by rapid improvement. The aim of this study was to investigate sequential neuroradiological changes in the brains of patients after SSD compared with those after brief cardiac arrest and hypoglycemia, which we previously studied with the same methods. Methods-We serially studied CT scans and MR images obtained at 1.5 T in 4 patients with SSD. All 4 patients suffered from transient neurological deficits due to cardiogenic embolus in ICA-MCA. The symptoms began to disappear from 25 to 50 minutes after onset. Results-Repeated CT scans demonstrated no abnormal findings in the affected cerebral hemisphere in 3 of the 4 patients and a small cortical infarct in the remaining 1. In each patient, repeated MRI between day 7 and month 23 after stroke showed basal ganglionic and cortical lesions. These lesions were hyperintense on T1-weighted and relatively hypointense on T2-weighted imaging. These ischemic lesions of hyperintensity on T1-weighted MRI subsided with time. Conclusions-Transient ICA-MCA occlusion leading to SSD produces a specific ischemic change with delayed onset in the basal ganglia and cerebral cortex in humans on MRI but not CT scans. We speculate that the lesions represent incomplete ischemic injury, including selective neuronal death, proliferation of glial cells, paramagnetic substance deposition, and/or lipid accumulation. Unlike brief cardiac arrest or hypoglycemia, the localized lesions on MRI of patients after SSD seem to be incomplete and to differ from infarction or hemorrhage. (Stroke. 1999;30:1038 -1042.)Key Words: carotid arteries Ⅲ cerebral ischemia, transient Ⅲ magnetic resonance imaging Ⅲ neuronal death T ransient internal carotid artery (ICA)-middle cerebral artery (MCA) occlusion due to cardiogenic embolus can lead to spectacular shrinking deficit (SSD) in patients with various heart diseases. 1 SSD refers to a sudden major hemispheric stroke syndrome followed by rapid improvement within a few hours after stroke, leaving mild or no deficits. Experimentally, 2,3 brief MCA occlusion (MCAO) causes selective neuronal necrosis and apoptosis with intact glial cells and microvessels in the caudoputamen and cerebral cortex. In these ischemic lesions, the brain tissue framework is preserved and no cavitation develops. This ischemic lesion with selective neuronal death and gliosis has been termed "incomplete infarction." 4 -6 Nakano et al 7 reported that selective neuronal damage slowly progressed in the dorsolateral striatum of rats for 4 weeks after 15 minutes' MCAO and that microvacuolation never occurred in the ischemic area. However, very few reports are available on the serial changes in the human brain after transient hemispheric ischemia leading to SSD, which represent the clinical equivalent of the experimental conditions described above.In humans, we previously invest...

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mentioning

confidence: 99%

Delayed Ischemic Hyperintensity on T1-Weighted MRI in the Caudoputamen and Cerebral Cortex of Humans After Spectacular Shrinking Deficit

Fujioka

Taoka

Hiramatsu

et al. 1999

Stroke

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“…The MR appearance of the abscess in this case is typical of a mature brain abscess, including pockets of T2-hyperintense material surrounded by a T2-hypointense rim, large amounts of vasogenic edema, and strong peripheral contrast enhancement [7][8][9]. One apparently distinct and as yet unexplained MRI feature of brain abscesses that was present in this case is the appearance of multiple rims on T2-weighted sequences (Figure 1(a) and inset).…”

Section: Discussionmentioning

confidence: 84%

“…CT and MRI characteristics of brain abscesses have been described in humans and domestic animals [1][2][3][4][5][6][7][8]. The MR appearance of the abscess in this case is typical of a mature brain abscess, including pockets of T2-hyperintense material surrounded by a T2-hypointense rim, large amounts of vasogenic edema, and strong peripheral contrast enhancement [7][8][9].…”

Section: Discussionmentioning

confidence: 91%

“…When this feature is present, the central hyperintense cavity of the abscess is bordered by concentric rings that are hypo-, then hyper-, and then hypointense; hyperintense edema then surrounds the lesion, giving it a target appearance. There is no known histopathologic correlate to these rings, though they may represent different layers of necrotic debris and inflammation or may be caused by an unknown artifact [7,10].…”

Section: Discussionmentioning

confidence: 99%

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Surgical Treatment of a Chronic Brain Abscess and Growing Skull Fracture in a Dog

Hodshon

Narak

Craig

et al. 2015

Case Reports in Veterinary Medicine

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A 2-year-old female spayed Miniature Dachshund was presented for seizures and right prosencephalic signs. A multiloculated, ring-enhancing mass in the right cerebrum associated with dilation of the right lateral ventricle and brain herniation was seen on magnetic resonance imaging. An irregular calvarial defect with smoothly scalloped edges was seen overlying the mass on computed tomography. The mass was removed via craniectomy and was diagnosed as a chronic brain abscess caused by Peptostreptococcus anaerobius. The patient was maintained on antibiotics for 12 weeks. Follow-up MRI performed 14 weeks after surgery confirmed complete removal of the abscess as well as a contrast-enhancing collection of extra-axial material consistent with a chronic subdural hematoma. The neurologic abnormalities, including seizures, have improved in the 44 months since surgery. Brain abscesses in dogs can have an insidious clinical course prior to causing serious neurologic deterioration. Ventricular entrapment by an intracranial mass can contribute to acute neurologic decline. If surgically accessible, outcome following removal of a brain abscess can be excellent; aerobic and anaerobic bacterial culture should be performed in these cases. Subdural hematoma can occur following removal of a large intracranial mass. Growing skull fractures can occur in dogs but may not require specific surgical considerations.

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“…MRV shows blood flow, sinus obstruction and subsequent reversal of flow [15]. MRI with gadolinium is more sensitive and specific than contrast CT in diagnosing early cerebritis [16,17]. MRI is the investigation of choice, and should be performed in conjunction with CT, there by fully evaluating associated otological and cerebral pathology [15].…”

Section: Discussionmentioning

confidence: 99%

Unilateral Attico Antral Ear Disease with Bilateral Intracranial Complications

Viswanatha

Sarojamma

Vijayashree

et al. 2011

Indian J Otolaryngol Head Neck Surg

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A 12 year old female patient, who had attico antral type of ear disease on right side, was brought to tertiary care centre for the management of fever, vomiting and headache. Patient had unilateral attico antral type of ear disease with bilateral intracranial complication. Along with the right attico antral type of ear disease and right lateral sinus thrombosis, patient had brain abscess in the left occipital lobe. Brain abscess was drained first and later mastoidectomy was done to eradicate the source of infection and to prevent further complications due to ear disease. Patient recovered well and patient was free from any problem during follow up period of 6 months. Bilateral intra cranial complications occurring simultaneously in a patient with a unilateral attico antral type of ear disease is not reported in the literature.

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MR imaging of brain abscesses

Cited by 238 publications

References 10 publications

Delayed Ischemic Hyperintensity on T1-Weighted MRI in the Caudoputamen and Cerebral Cortex of Humans After Spectacular Shrinking Deficit

Delayed Ischemic Hyperintensity on T1-Weighted MRI in the Caudoputamen and Cerebral Cortex of Humans After Spectacular Shrinking Deficit

Surgical Treatment of a Chronic Brain Abscess and Growing Skull Fracture in a Dog

Unilateral Attico Antral Ear Disease with Bilateral Intracranial Complications

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