Presentation
Vomiting, headache, and neck rigidity.
Patient Data
There is a lobulated-outlined, rim-enhancing lesion showing central diffusion restriction in the right temporal lobe with surrounding marked edema and midline shift (about 1 cm) toward the left side.
Another tiny ring-enhancing lesion is seen in the right frontal lobe periventricular white matter.
Dilatation of lateral ventricles with transependymal CSF leakage.
Ependymal enhancement of right lateral ventricle with multi-focal areas of diffusion restriction in the ventricular system.
Heterogeneous high signal of right mastoid air cells and right middle air cavity.
There is also thrombosis of the right transverse and sigmoid sinuses.
Evidence of discontinuity of tegmen tympani on the right side.
Mild basal meningeal enhancement is noted.
Case Discussion
The features are suggestive of abscess formation in the right cerebral hemisphere lobe with features of acute ventriculitis most likely secondary to right oto-mastoiditis.
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