PMC5960533_01
Initially, (a) a noncontrast computed tomography (CT) and (b) a computed tomography angiography (CTA) of the head performed on at the time of the admission showed no abnormalities and vascular malformations.
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A preoperative computed tomography (CT) of the head and CT angiogram of the brain (CTA) scan on admission showed no abnormalities and vascular malformations (Figures 1(a) and 1(b)).
A contrast-enhanced CT scan of abdomen showed (a) rounded hypodense lesion with central low attenuation in the right lobe of the liver (suggestive of liver abscess) and (b) hypodense splenic air-filled lesion with an irregular wall (suggestive of perisplenic infection).
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The patient was diagnosed with liver abscess, perisplenic and intracranial infection, and septicemia; a contrast-enhanced CT scan of the abdomen showed rounded hypodense lesion with central low attenuation in the right lobe of the liver and a hypodense splenic air-filled lesion with an irregular wall (Figure 2).
Brain MRI performed on the third day revealed (a) high signal intensity on DW image and (b, c) well-defined rounded cystic lesion on the T2-weighted and T1-weighted images involving in the right corona radiata and basal ganglia, compressing the right lateral ventricle with midline shift to left, suggestive of an early stage of brain abscess.
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On the third day in the hospital, magnetic resonance imaging (MRI) of the head showed high signal intensity on DW image and well-defined rounded cystic lesion on the T2-weighted and T1-weighted images involving in the right corona radiata and basal ganglia (Figure 3), although the lesion looks like that of an acute stroke but lately was confirmed to be early stage of cerebral abscess.
Noncontrast head CT performed on the 7th day demonstrates an acute hemorrhage in the right occipital lobe, with surrounding oedema and compressing the right lateral ventricle with midline shift to left.
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On the seventh day, the patient was noted to have worsening neurological status and left extremity weakness and a repeat computed tomography (CT) scan revealed a right occipital lobe hematoma with blood loss of 40 ml (Figure 4).
A contrast-enhanced MR imaging of brain performed three days after operation showed irregular mixed signal intensity on DWI with enhancement of its wall in the right occipital lobe and hyperintense lesion with small hypointense areas within in the basal ganglia region.
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During the first three postoperative days the patient was delirious; further MRI of the brain three days after operation showed multiple hemorrhagic lesions involving both cerebral hemispheres and cerebellum and a cystic lesion in the basal ganglia region (Figure 5).
Contrast-enhanced CT of head 30 days after the initial ischemia showed a ring-enhancing cystic lesion in the right basal ganglia with perilesional oedema, which compressed right lateral ventricle with midline shift towards left suggestive of abscess.
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Contrast-enhanced CT of the head showed a well-defined lesion, with thin, ring-like enhancement pattern in the right basal ganglia with perilesional edema, which compressed right lateral ventricle with midline shift towards left and was given the possibility of brain abscess (Figure 6).