PMC7176937_01
(A) Pre-admission non-contrast CT scan of the patient, revealing a 2-cm hyper-dense lesion located at the midline at the level of the 3rd ventricle. (B) Axial, non-contrast T1-weighted(T1WI)MRI, (C) Coronal, post-contrast T1WI MRI and (D) Diffusion-weighted MRI were obtained upon admission, demonstrating a hypodense multiloculated lesion in the left thalamus with annular enhancement of the abscess wall. (E) and (F) Single voxel MR spectroscopy (MRS) showing decreased N-acetylaspartate peak and a slightly increased choline peak of the right thalamic mass. (G) Axial, post-contrast T1WI MRI and (H) Diffusion-weighted MRI on day 14, demonstrating restricted diffusion and rim enhancement. Axial post-contrast MRI (I) one week, (J) 1 month, (K) 2 months following the drainage of the abscess and (L) Axial non-contrast CT scan obtained at 6-month follow-up. (M) Continuous quantitative EEG monitoring showing normal bilateral cerebral blood flow with no significant epileptiform activity.
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The lesion was hypointense to the brain parenchyma on T1-weighted (T1W1) magnetic resonance (MR) imaging and was associated with significant peri-lesional edema (Fig. 1A-D). Single voxel MR spectroscopy (MRS) showed a slightly increases choline peak of right thalamic mass (Fig. 1E-F). Continuous quantitative EEG showed normal bilateral cerebral blood flow with no significant epileptiform activity (Fig. 1M). The opening of the abscess into the ventricle was confirmed by diffusion weighted MR imaging (Fig. 1G-H). Repeated post-contrast MR imaging one week after the drainage of the abscess revealed that the lesion reduced in size (Fig. 1I). MR imaging obtained on day 30 following the drainage of the abscess, revealed a further decrease in size of the lesion compared to previous images (Fig. 1J). After a 3-month course of treatment, coronal MR imaging showed complete resorption of the lesion (Fig. 1K). At 6-month follow-up, the patient made excellent recovery with no residual or recurrent abscess (Fig. 1L).