Brain Abscess

Findings:

Irregular rim enhancing lesion left parietooccipital lobe with surrounding edema and mild mass effect. Central locules show prominent diffusion restriction. Rim of lesion is T1 precontrast hyperintense with spotty hypointenseity on GRE.

Differential diagnosis:

Abscess, Necrotic primary or metastatic neoplasm.

Discussion:

-early cerebritis (3-5d), late cerebritis (2 wks), early capsule (>2 wks), late capsule (wks-mos)

-only 50% have fever or WBC count, 90% have headache, most have high ESR

-less than 2.5 cm may be treated with Abx alone,  greater need drainage

-internal DWI hyperintensity characteristic, some help in dist GBM/mets from abscess, not absolute

-DWI may be helpful in f/u, development of hyper DWI may indicate recurrence

-T2 hypointense rim with late cerebritis and early capsule, also not absolute

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