J Korean Med Sci.  2008 Dec;23(6):1102-1104. 10.3346/jkms.2008.23.6.1102.

Serial Magnetic Resonance Imagings of Multiple Brain Abscesses in a Patient with Pneumococcal Meningoencephalitis

• Hong JM
• Choi JY
• Park HY
• Huh K

• KMID: 1107539
• DOI: http://doi.org/10.3346/jkms.2008.23.6.1102

Abstract

We report a 43-yr-old man manifesting bacterial meningoencephalitis and multiple abscesses by Streptococcus pneumoniae. Serial magnetic resonance (MR) imagings and MR spectroscopy showed the evolution of multiple brain abscesses over 4 weeks: the enhanced rings became thicker and the dimension of whole lesions larger despite shrinkage of the ring-enhanced regions. These findings may be evidence of active inflammation working to sequestrate the lesion and protect the surrounding normal brain parenchyma from additional damage, even in the final stage of the brain abscess.

Keyword

Streptococcus pneumoniae; Multiple Abscesses; Magnetic Resonance Imaging

MeSH Terms

Brain Abscess/*diagnosis
Diagnosis, Differential
Humans
Magnetic Resonance Imaging
Male
Meningoencephalitis/*diagnosis
Middle Aged
Pneumococcal Infections/*diagnosis
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 The patient's brain MR imagings according to time sequence. T2WIs showed multiple small hyperintense lesions in the bilateral subcortical borderzones with the dimensions of these lesions increasing in width. DWIs showed these lesions as very hyperintense with a heterogenous ADC value in the early phase (HD 1 and HD 7), but these lesions became homogenous hyperintense lesions in ADC values. Gadolium-enhanced T1WIs showed that the ill-defined and ring-enhanced lesions occurred on HD 7. The rim of these lesions gets thicker while the size of ring-enhanced lesions shrunk, but the dimension of hypointensity became larger.

• 

  Fig. 2 The MR spectroscopy (MRS) image from the patient. A single voxel showed resonances representing choline (Cho), creatine (Cr), and N-acetylaspartate (NAA), lipid and lactate, and amino acids (AA).

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