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Joseph Junewick, MD FACR
over 5 years ago
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Intracranial Abscesses

Case Detail

Anatomy: Brain-Spine
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Infectious-Inflammatory
Created: over 5 years ago
Updated: over 5 years ago
Tags: PEDS
Modality/Study Types: MR
Activities:
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History

8 year old with headache and visual disturbance.


Case Images


Diagnosis

Intracranial Abscesses

Findings

MR – Axial T2 and postgadolinium images show junctional ring-enhancing lesions with a halo of edema in the right occipital and left parietal regions. MR spectroscopy shows large lactate doublet at 1.4.

Discussion

Ring-enhancing lesions of the central nervous system are most often neoplasia (primary or metastatic tumors) and much less often other etiologies such as abscess or demyelinating disease. A single ring-enhancing lesion is most likely neoplasm whereas multiple ring-enhancing lesions are most likely abscesses or demyelinating disease. Abscesses typically manifest as subcortical or deep lesions with cavitation. Metastatic lesions often become ring-enhancing because of necrosis (eg, after chemotherapy or irradiation). Patients with subacute bacterial endocarditis, indwelling catheters, or other implanted devices such as cardiac valves are prone to develop abscesses.

Pyogenic infections of the CNS usually arise from septic emboli and less frequently from transdural spread (usually adjacent sinus infections). After an initial unorganized inflammation or cerebritis, the successful immune response will include angiogenic neovascularity and collagen deposition leading to a capsule of granulation tissue. Perilesional vasogenic edema is variable. An abscess is the result of organization and partial neutralization of an infection. It takes about 2-4 weeks to form a mature capsule.

The organizing infection forms concentric zones. The central portion represents necrotic brain. Reactive white cells (macrophages, monocytes) and fibroblasts surround the necrotic brain. Capillary proliferation and collagen deposition result in capsule formation. The peripheral most layer is comprised of reactive astrogliosis and vasogenic edema.

Reference

Smirniotopoulos JG, Murphy FM, Rushing EJ et al. Patterns of Contrast Enhancement in the Brain and Meninges. RadioGraphics (2007): 27:525-551.



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