CT Case 079

There is a peripherally enhancing smooth walled lesion in left basal ganglia with significant perilesional oedema and mass effect.

There is midline shift to right and mild effacement of the left lateral ventricle.

MRI further demonstrates the peripherally enhancing lesion with extensive oedema.

This patient went for neurosurgery, burr hole with stereotactic needle aspiration of the mass, 8ml of purulent material was removed, confirming this to be a cerebral abscess.

Culture confirmed this to be Methicillin resistant Staphylococcus aureus (MRSA).

Cerebral abscess is uncommon in Western countries, with an incidence of 1-2% of all intracranial masses.

A major risk factor is an immunocompromised state, such as HIV, or as in this patient, lymphoma on immunotherapy.

Cerebral abscess can result either from haematogenous spread or locally from head and neck infections, most commonly paranasal sinus infections which are responsible for 30-50% of cases.

Pathogens are most frequently Staphylococcus aureus and Viridans streptococci.

Prevalence is highest in men younger than 30 years, and in the paediatric population between ages of 4 to 7.

Symptoms are often quite indolent, which often results in a delay in the diagnosis being made.

Commonly patients present with symptoms of fever, headache, and altered mental state, seizure or focal neurology.

Treatment is usually a combination of surgical and medical therapy.

Following needle aspiration this patient received a prolonged course of IV flucloxacillin.

• Bokhari MR, Mesfin FB. Brain Abscess. StatPearls