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 Table of Contents    
CLINICAL IMAGE
Year : 2021  |  Volume : 14  |  Issue : 2  |  Page : 122-123  

Brain abscess: Appearance on Magnetic Resonance Imaging


1 Department of Pediatric Ophthalmology, Strabismus, and Neuro Ophthalmology, Nimmagada Prasad Children's Eye Care Centre, Child Sight Institute, GMRV Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
2 Department of Pediatric Ophthalmology, Strabismus, and Neuro Ophthalmology, Child Sight Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India

Date of Submission16-Apr-2020
Date of Decision07-Jun-2020
Date of Acceptance06-Sep-2020
Date of Web Publication28-Jun-2021

Correspondence Address:
Dr. Rajat Kapoor
Department of Pediatric Ophthalmology, Strabismus, and Neuro Ophthalmology, Nimmagada Prasad Children's Eye Care Centre, Child Sight Institute, GMRV Campus, L V Prasad Eye Institute, Visakhapatnam, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ojo.OJO_94_2020

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How to cite this article:
Dubay S, Sachdeva V, Kekunnaya R, Badakere A, Kapoor R. Brain abscess: Appearance on Magnetic Resonance Imaging. Oman J Ophthalmol 2021;14:122-3

How to cite this URL:
Dubay S, Sachdeva V, Kekunnaya R, Badakere A, Kapoor R. Brain abscess: Appearance on Magnetic Resonance Imaging. Oman J Ophthalmol [serial online] 2021 [cited 2021 Aug 3];14:122-3. Available from: https://www.ojoonline.org/text.asp?2021/14/2/122/319494



A 25-year-old male presented with the complaint of blurred vision in the right eye. There were no systemic complaints such as headache, seizures, and fever. There were no other ocular complaints. The patient had an unaided distance and near visual acuity of 20/20, N6 in both eyes. The anterior and posterior segment evaluation of both eyes was within normal limits. There was absence of any pupil abnormalities and optic disc changes such as edema and pallor. Gross systemic neurological examination including motor and sensory examination was normal. On Humphrey visual field (24-2 SITA-FAST strategy), he had an incongruous right hemifield defect. The visual field was more affected in the right eye as compared to the left eye. A magnetic resonance imaging (MRI) scan was subsequently requested and it illustrated the following: on axial MRI T1-weighted and T2-weighted images, there was an irregular lesion with central necrosis located in the medial aspect of the left occipital lobe.[1],[2] There was perilesional edema with mass effect on the lateral ventricle.[2] The wall of the lesion showed a smooth and complete ring-like enhancement on postcontrast T1 image coronal and sagittal sections [Figure 1].[3] This represents the classical radiographic features of a brain abscess.[3],[4] The wall of an abscess is malleable and follows the contour of adjacent structures and does not cause space-occupying effect in early disease, thus it can present with only visual field loss if located in proximity to the occipital lobe without any other ocular or systemic symptoms. A suspicious visual field examination thus warrants an MRI examination to avoid missing any underlying sinister problem. On diagnosis, the patient was referred to a neuro-physician, who started the patient on intravenous antibiotics (cefotaxime and metronidazole) after routine blood investigations and cerebrospinal fluid analysis. On 3-month follow-up, the patient was asymptomatic and repeat visual field examination was reported normal.
Figure 1: (a) Axial section of T1-weighted magnetic resonance imaging showing an irregular lesion (white arrow) with areas of central necrosis (white star) in the medial aspect of the left occipital lobe. (b) Axial section of T2-weighted magnetic resonance imaging showing an irregular lesion (black star) with perilesional edema (black arrow). (c) Coronal section of T1- weighted magnetic resonance imaging with gadolinium contrast showing complete ring-like enhancement of the lesion wall (black arrow) following the contours of the brain structures. (d) Sagittal section of T1-weighted magnetic resonance imaging with gadolinium contrast showing complete ring-like enhancement of the lesion wall (white arrow)

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

We thank our diagnostic and photographic teams of L V Prasad Eye Institute, GMRV Campus, for their support in patient management and documentation of the clinical pictures and investigations.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Muzumdar D, Jhawar S, Goel A. Brain abscess: An overview. Int J Surg 2011;9:136-44.  Back to cited text no. 1
    
2.
Chang SC, Lai PH, Chen WL, Weng HH, Ho JT, Wang JS, et al. Diffusion-weighted MRI features of brain abscess and cystic or necrotic brain tumors: comparison with conventional MRI. Clin Imaging 2002;26:227-36.  Back to cited text no. 2
    
3.
Haimes AB, Zimmerman RD, Morgello S, Weingarten K, Becker RD, Jennis R, et al. MR imaging of brain abscesses. AJR Am J Roentgenol 1989;152:1073-85.  Back to cited text no. 3
    
4.
Longo D, Narese D, Fariello G. Diagnosis of brain abscess: A challenge that magnetic resonance can help us win! Epidemiol Infect 2018;146:1608-10.  Back to cited text no. 4
    


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