PMC7085370_01
Brain abscess detected by contrast-enhanced computed tomography and magnetic resonance imaging. (a) Contrast-enhanced computed tomography scan showing a low-density area with ring enhancement. (b) T2-weighted fluid-attenuated inversion recovery image showing a hyperintense lesion surrounded by a thin hypointense ring. Hyperintense edema is noted. (c) Diffusion-weighted magnetic resonance image demonstrating a hyperintense signal within the lesion. (d) Apparent diffusion coefficient map shows hypo-intensity within the lesion, confirming the presence of restricted diffusion.
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fig1
Contrast-enhanced computerized tomography revealed a ring-enhanced lesion (15 mm x 10 mm) with perilesional edema on the posterior limb of internal capsule in the left cerebral hemisphere, with a midline shift (Figure 1(a)). Magnetic resonance imaging also demonstrated a ring-enhancing lesion (15 mm x 10 mm) with a large amount of adjacent edema and mass effect (T2-weighted fluid-attenuated inversion recovery; Figure 1(b)). Diffusion-weighted magnetic resonance imaging revealed a markedly hyperintense lesion with a low apparent diffusion coefficient (Figures 1(c) and 1(d)).
Clinical course of the patient. Neurological symptoms and computed tomography findings are improved by antimicrobial therapy, drainage, and antiedema therapy with glycerol and an herbal Kampo medicine goreisan. WBC, white blood cell count; CRP, C-reactive protein; CTRX, ceftriaxone; MEPM, meropenem; VCM, vancomycin.
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fig2
The clinical course of the patient is shown in Figure 2.