34 Y/O man with decrease LOC

 

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Doctor's Information

Name : Seyed Morteza
Family : Bagheri
Affiliation :Hasheminejad Hospital,IUMS
Academic Degree : Assistant Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Mohsen Hasanzadeh

 

Case Section

Neuroradiology

 

Patient's Information

Gender : Male
Age : 34

 

Clinical Summary

34 Y/O man with decrease LOC

 

Imaging Findings

Loss of normal signal void at Right Carotid, MCA, and ACA in pericontrast images is seen that shows non enhancing filling defect and accompanied with peripheral enhancement(blue arrow). The MCA has nodular border(red arrow). Multiple rim enhancing lesions, mostly at corticomedullary junctions at right side are evident. Superficial gyral enhancement is noted. Scattered area of high T1 at frontal lobe is infavour of micro bleedings. Combination of vasogenic and cytogenic edema (restricted in D/W images (yellow arrow)) is present that produced about 9 mm subfalcian herniation and mild right side uncal herniation(green arrow). Large rim enhancing cavitary lesion with air-fluid level in Right parieto-occiptal region is noted which contain high internal signal at T1, T2, Flair sequences that cause mass effect on underlying parenchyma. There is no evidence of restriction in D/W images, wall T2 hyointensity .the ventricular side of collection is thicker than cortical side. These finding is not compatible with abscess formation. Small subgaleal collection at right parieto-occipital area at surgical site is seen (brown arrow)

 

Differential Diagnosis

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Final Diagnosis

Septic emboli from infected carotid thrombosis & meningitis

 

Discussion (Related Text)

Bacterial endocarditis, congenital heart disease, and intravenous drug abuse are common risk factors in the pathogenesis of septic emboli. Large septic emboli may occlude major cerebral arteries and may result in ischemic infarcts. Small emboli typically result in multiple small abscesses that characteristically are located at the junction between cerebral gray and white matter (corticomedullary junction). The localization of septic abscesses is similar to that of widespread cerebral metastases. Often, but not always, the abscesses are surrounded by extensive perifocal edema. A possible complication of septic emboli is the formation of infectious (‘‘mycotic’’) aneurysms. In contrast to the much more common noninfectious aneurysms at the main branches of the circle of Willis, infectious aneurysms are located in small-sized arteries located distally to the main branches of the circle of Willis

 

References

Inflammatory Disease of the brain, page 50

 

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