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NEUROIMAGE
Year : 2009  |  Volume : 57  |  Issue : 1  |  Page : 100-101

Giant hemispheric multiloculated brain abscess


Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R., China

Date of Acceptance26-Jan-2009

Correspondence Address:
Bo-yong Mao
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan province, 610 041, P.R.
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.48795

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How to cite this article:
Liu Wk, Ma L, Mao By. Giant hemispheric multiloculated brain abscess. Neurol India 2009;57:100-1

How to cite this URL:
Liu Wk, Ma L, Mao By. Giant hemispheric multiloculated brain abscess. Neurol India [serial online] 2009 [cited 2021 Mar 6];57:100-1. Available from: https://www.neurologyindia.com/text.asp?2009/57/1/100/48795


A two-year-old baby was reffered to pediatric clinic for decreased appetite, pharyngeal congestion and lethargy. The pediatrician made a diagnosis of pharyngitis. Vital signs were normal and neurological examination revealed decreased muscle tone in the left sided limbs and right ptosis. The left pupil diameter was 2mm whereas it was 5mm on the right side. The white blood cell count was 8.04 10 9 /L with differential counts of 67% neutrophils. Magnetic resonance imaging (MRI) revealed a giant cerebral hemispheric multiloculated lesion, which was hypointense on T1-weighted image and hyperintense on T2 [Figure 1].

The preoperative diagnosis was cystic glioma or other ill-defined diseases. During the operation, a thick-walled giant multiloculated abscess containing thick pus was seen. The pus grew Staphylococcus aureus . Pathological examination also confirmed brain abscess [Figure 2a]. Patient recovered well without any neurological defect post-operatively. Follow-up computed tomography (CT) scan done at three months revealed no residual abscess [Figure 2b].

Differentiation between multiloculated brain abscess and cystic brain tumors such as low-grade glioma is often difficult with conventional and diffusion MRI. [1] In our patient the brain abscess was possibly of otogenic origin as the child had pharyngeal inection, in the past which could easily lead to tympanitis and hemispheric brain abscess. This is because the short and wide auditory tube in a child can get easily infected.

Surgical treatment should be attempted for reducing the mass effect, obtaining the pathologic diagnosis, and identifying infecting pathogens for facilitating selection of antibiotics. [2] Excision seemed to be the most appropriate surgical choice for multiloculated abscess as recommended by Loftus et al . [3]



 
  References Top

1.Erdogan C, Hakyemez B, Yildirim N, Parlak M. Brain abscess and cystic brain tumor, discrimination with dynamic susceptibility contrast perfusion-weighted MRI. J Comput Assist Tomogr 2005;29:663-7.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Kratimenos G, Crockard HA. Multiple brain abscess: A review of fourteen cases. Br J Neurosurg 1991;5:153-61.  Back to cited text no. 2  [PUBMED]  
3.Loftus CM, Osenbach RK, Biller J. Diagnosis and management of brain abscess. In: Wilkins RH, Rengachary SS, editors. Neurosurgery. New York: McGraw-Hill Press, 1996. p. 3285-98.  Back to cited text no. 3    


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  [Figure 1], [Figure 2a], [Figure 2b]



 

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