PMC9898726_01
(A) Day 1; Innumerable ring-enhancing central restriction diffusion lesions predominately involving the supratentorial brain with proclivity for the basal ganglia, thalami and gray-white matter junction, resulting in prominent disease burden and edema causing mass effect on the lateral ventricles. Additionally, midbrain lesion causing partial effacement of cerebral aqueduct. (B) Day 3; Redemonstration of lesions with milder involvement of the brainstem and bilateral cerebellum. Vasogenic edema appreciated. (C) Readmission Day 1; Interval development of hydrocephalus and ventriculitis. Left lateral ventricle periventricular/intraventricular lesions measure up to 3.1 cm with surrounding edema, consistent with NCC in colloidal vesicular phase. Left to right midline shift 0.4 cm. Demonstration of innumerable lesions now in nodular calcified stage. Right basal ganglia with findings indicative of pus.
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A magnetic resonance imaging [MRI] showed innumerable ring-enhancing lesions, see Fig. 1.
(A) Readmission Day 1; 5 mm left to right midline shift. Left lateral ventricle is compressed. Extensive bilateral white matter edema in left frontal and parietal lobe, with 3.4 x 2.4 cm round mass. (B) Readmission Day 2; Worsening global edema and mass effect on basal cisterns and ventricles. Moderate hydrocephalus. Early blurring of gray-white matter differentiation. (C) Readmission Day 2; Interval placement of EVD. Ventricles are completely decompressed and flattened. Worsening diffuse edema with absence of cerebral edema. (D) Readmission Day 3; Diffuse brain swelling with effaced basilar cisterns and sulci. Slight rightward midline shift.
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CT head demonstrated a 5 mm left to right midline shift, a mass in the left hemisphere with adjacent mass-effect resulting in compression of left ventricle with surrounding edema concerning for an abscess, see Fig. 2.