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Case of the Month

by Dr Noreen Norfaraheen Lee Abdullah MD (UKM), MMed Radiology (UKM), AM(Mal)

Answer to Case Of the Month 
Multiple Brain Abscesses

Discussion of Findings
There were two well-defined hypodense lesions with rim enhancement in the left fronto-parietal region and another lesion at the right occipital region. The lesions were associated with significant perilesional edema. The lesions in the left fronto-parietal region measured 4.3 cm x 4.7 cm, and the right occipital region was 2.5 cm x 3.7cm in size. This was associated with mass effect and midline shift to the right side and minimal subfalcine herniation. The right occipital horn of the lateral ventricle was displaced upwards due to mass effect from the right occipital lesion. The lateral ventricles and basal cisterns were not dilated.

The conclusion was multiple brain abscesses.
Brain Abscess
Brain abscess is also known as cerebral infection. Most of the infections are acquired due to contiguous spread from mastoiditis, sinusitis or facial infections. Occasionally it is due to the septic emboli from the heart when the child has a left to right shunt. Sometimes it may be secondary to hematogenous spread, penetrating trauma or surgery. Causative organisms may be viral, bacterial or fungal.

Cerebral infection is divided to three stages. The earliest stage is the encephalitis stage, which then on progresses to cerebritis and then to the development of the ill defined capsule, which is better known as the abscess formation. The capsule may be thick and the contents within decrease in attenuation indicating a well-formed abscess. Ring enhancement is the typical finding on CT or MRI scans. Progressive destruction or liquefaction necrosis of cerebral tissue results in diffuse cystic encephalomalacia.
 
About the Author 
Dr Noreen, a Consultant Radiologist is currently with the Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
 
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Last Updated:
Tuesday, 01 January 2008