Brain abscess
Supratentorial(temporal lobe) Pathogen:MRSA,streptococcus,pneumococcus Periodization
acute encecapsule formation stage
Primary leision(lung,braest,melanoma) Multiple Supratentorial(80％)，subtentorial(20％) Cortex-medullary junctions
Imaging
Isointensity on T1WI Iso- or mildly hypointensity on T2WI “small nodule and big edema” sign necrosis and cystic degeneration obvious nodular or ringlike enhancement
2013-1-15
2013-1-22
Diagnosis
Cerebral Cysticercosis
epidemiology
most commonly in the whole body cysticercosis(80％) most commonly in cerebral parasitic disease more prevalent in the country Pathogen: the cysticercus of armed tapeworm
intracranial tuberculosis
Children and youth Classification
tuberculous meningitis tuberculoma tuberculous brain abscess
IMAging
Tuberculous meningitis hydrocephalus distention of subarachnoid spaces abnormal meningeal and cistern
Calcification stage lower signals on T1WI and T2WI peripheral edema disappearance
Mixed stage
Enhanced scanning:ringlike enhancement
DDX
Intracranial tuberculosis Metastatic encephaloma Brain abscess
Case Discussion
By Head Group 2013-5-9
History
Female,48Y Sudden onset;headache, nausea and vomit for
10 years; aggravation for 1 day CSF culture(－)
2013-1-2
enhancement
Tuberculoma space-occupying effect hydrocephalus calcification “target sign” ringlike or eggshell-like enhancement
Metastatic encephaloma
immunological examinations
CAg: activity of neurocysticercosis IgG4:therapy effect IHA/ELISA:supplementary indicator
treatment
Medical treatment : active stage albendazole+praziquantel
acute encephalitis stage low signal on T1WI,high signal on T2WI
suppuration and capsule formation stage the wall: complete,smooth,thin,homogeneous circular enhancement “dark belt” sign
Imaging
Active stage
small excentric spotty shadow of the mural cysticercus scolex low signals on T1WI,high signals onT2WI capsular liquid : higher than CSF on FLAIR unremarkable peripheral edema
Surgical operation : degeneration and death stage&granulomatous stage
cysticercosis enucleation decompressive craniectomy ventriculoperitoneal shunt
Conclusion
Degeneration and death stage scolex disappearance enlarged capsular cavity remarkable peripheral edema “white/black target sign” “multi-ring sign” “delanminated sign”
classification
Parenchymal Ventricular(the third or fourth) Meningeal Mixed
periodization
Subclinical stage Active stage Degeneration and death stage Calcification stage Mixed stage