Neuroimaging Cases 003

Atraumatic neurosurgical intracranial infections

Latest instalment in our neuroimaging series. Images, text and cases collated by Trent VanHorn MD, Faith Meyers MD and Steven Perry MD. First published on EMGuideWire.com and peer reviewed by Professor Michael Gibbs.

Cases reviewed

• Case 1: 19-year-old female with history of Potts Puffy Tumour requiring endoscopic trans-nasal drainage presented to the ED on post-operative day 9 with lightheadedness, fever, and increased forehead swelling.
• Case 2: 79-year-old female with a history of chronic, refractory sinusitis (several different courses of antibiotics given) presents with one week of forehead swelling.
• Case 3: 50-year-old with a history of hypertension presents to the emergency department with right arm tingling and difficulty speaking.
• Case 4: 50-year-old male with a history of diabetes presents with fever, headache, neck pain and vomiting.
• Case 5: Healthy 48-Year-Old With Right-Sided Headache.

References

• Nicoli TK, Mäkitie A. Images in clinical medicine. Frontal sinusitis causing epidural abscess and puffy tumor. N Engl J Med. 2014 Mar 13;370(11):e18
• Omar AT 2nd, Khu KJO. Successful management of intraventricular rupture of pyogenic brain abscess (IVROBA): Systematic review and illustrative case. J Clin Neurosci. 2020 Jan;71:191-198.
• Osborn MK, Steinberg JP. Subdural empyema and other suppurative complications of paranasal sinusitis. Lancet Infect Dis. 2007 Jan;7(1):62-7.
• French H, Schaefer N, Keijzers G, Barison D, Olson S. Intracranial subdural empyema: a 10-year case series. Ochsner J. 2014 Summer;14(2):188-94.
• Brouwer MC, Tunkel AR, McKhann GM 2nd, van de Beek D. Brain abscess. N Engl J Med. 2014 Jul 31;371(5):447-56.
• Sonneville R, Ruimy R, Benzonana N, Riffaud L, Carsin A, Tadié JM, Piau C, Revest M, Tattevin P; ESCMID Study Group for Infectious Diseases of the Brain (ESGIB). An update on bacterial brain abscess in immunocompetent patients. Clin Microbiol Infect. 2017 Sep;23(9):614-620.
• Reddy JS, Mishra AM, Behari S, Husain M, Gupta V, Rastogi M, Gupta RK. The role of diffusion-weighted imaging in the differential diagnosis of intracranial cystic mass lesions: a report of 147 lesions. Surg Neurol. 2006 Sep;66(3):246-50; discussion 250-1.
• Corsini Campioli C, Castillo Almeida NE, O’Horo JC, Esquer Garrigos Z, Wilson WR, Cano E, DeSimone DC, Baddour LM, Van Gompel JJ, Sohail MR. Bacterial Brain Abscess: An Outline for Diagnosis and Management. Am J Med. 2021 Oct;134(10):1210-1217.e2.

This neuroimaging interpretation series is proudly sponsored by the Emergency Medicine Residency Program at Carolinas Medical Center. The goal is to promote widespread mastery of CXR interpretation. There is no personal health information [PHI] within, and ages have been changed to protect patient confidentiality.