PNR Head 18

History

3 yo M with unrepaired transposition of the great vessels, VSD, fever for one week, and leukocytosis

Major Findings

Right frontoparietal abscess with extensive vasogenic edema causing midline shift and right uncal medialization
Obstructive hydrocephalus with intraventricular debris in the left posterior horn and cisterna magna (subtle, better seen on MRI)

Teaching Points

Just like any other space-occupying lesion, when you see an abscess, look for associated mass effect (i.e. midline shift, uncal medialization, transtentorial herniation, tonsillar herniation etc.).

Be familiar with complications of various brain herniations (arterial clipping/infarction, venous compression/infarction), cranial nerve compression etc).

Here is a link to a great article on the topic of acquired brain herniations:

When there is concern for intracranial infection, look carefully for debris in the ventricles as a sign of ventriculitis. Also look for edema surrounding the ventricles.

Accession: CL0640

Study description: CT HEAD WO CONTRAST