Brainstem abscess: diagnostic challenges in two similar clinical cases

Written by Sipos Ildikó, Vastagh Ildikó, Petercsák Edina, Rudas Gábor, Várallyay György, Valikovics Attila, Bereczki Dániel

Brain abscess is a rare and often fatal disease. Bacterial infections of the brain could develop by direct extension of local infections e.g. sinusitis, otomastoiditis, or due to hematogenous spread. Headache, fever and focal neurological deficits are the leading clinical symptoms and signs in brain abscess. Pathogen detection by CSF examination or by microbiological methods from needle aspiration or stereotaxic samples is often unsuccessful. Imaging studies are the keys for the diagnosis. The abscess in contrast enhanced CT scan may be represented as a low density area, which is similar to a subacute ischaemic lesion. Meanwhile, the pyogenic lesion is characterized with MR as a hypointense region on T1 and hyperintense region on T2 and FLAIR images. Diffusion weighted images (DWI) could distinguish between tumours and abscesses. As an empiric treatment, combined intravenous - clindamycine / metronidazole + 3d generation cephalosprin - antibiotic therapy is recommended. In this article we report two cases of brainstem abscess developed in immunocompetent patients. The diagnosis was based partially on the imaging studies and partially on the successful outcome of combined antibiotic treatment.


Keywords: brainstem, abscess, magnetic resonance imaging, management

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