Does this confirm the diagnosis of cerebral abscess? What complication is occurring which requires expedient surgical management?
Yes, appearances are typical of a cerebral abscess, which is extending through the cortex.
Lobulated mass measuring 22 x 17 x 17 mm centred on the grey-white matter junction in the right posteroinferior frontal lobe demonstrates isointense FLAIR signal, hyperintense central T2 signal with a rim which is T2 hypointense, and slightly T1 hyperintense signal with thick peripheral contrast enhancement. The lesion involves the cortex and appears to have ruptured through the cortex with adjacent meningeal enhancement. It is surrounded by increased FLAIR signal, most in keeping with vasogenic oedema. There is associated mass effect with effacement of adjacent sulci and leftward midline shift of 4 mm at the level of the third ventricle. The mass demonstrates restricted diffusion and reduced ADC. There is an area of restricted diffusion involving the adjacent cortex also.
MRI spectroscopy in voxel at the medial margin of the lesion demonstrates depleted NA-A, decreased choline, increased lactate and slightly increased myo-inositol. Possible increased amino acids.
There is an old infarct in the left parieto-occipital region extending to the ventricular surface, with ex-vacuo dilatation of the posterior aspect of left lateral ventricle.