Diagnosis: Cerebral abscess
Patients with cerebral abscess typically present acutely toxic. A ring enhancing mass with an irregular, shaggy wall is classic. Mass effect and vasogenic edema are common. They are usually at the gray-white junction and are more commonly in the frontal and temporal lobes. Gas maybe present within the lesion depending upon the organism. Etiologies include paranasal sinus infection and mastoiditis as well as generalized sepsis or congenital heart disease with a right to left shunt. Patients with Osler-Weber-Rendu disease are at a higher risk for cerebral abscess secondary to the effective right to left shunt seen in their pulmonary AVMs. Patients who are immunsuppressed (diabetes, AIDS, cancer) are predisposed to cerebral abscess. Streptococcus is the most common organism. The combination of a ring enhancing mass with overlying calvarial erosion and frontal sinus opacification strongly suggests the diagnosis of a cerebral abscess. Much less likely, a highly aggressive malignant neoplasm may simulate this appearance. At surgery, this patient had purulent, necrotic material removed from the left frontal lobe with a severe ventriculitis. The ventriculitis likely produced stenosis of the cerebral aqueduct resulting dilatation of the third and lateral ventricles. The patient died shortly after surgery. Related Cases
