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60 year-old with diabetes and renal disease presents with progressive aphasia

60 year-old with diabetes and renal disease presents with progressive aphasia

CT noncontrast

CT postcontrast

FLAIR

T1 noncontrast (Gad not given due to renal disease)

GRE

DWI

ADC

MR spectroscopy single voxel: control right brain


Findings:

Multiple ring-enhancing partially hemorrhagic mass lesions with restricted diffusion and high lactate (1.3 PPM)

DDX:

Metastases Abscess Subacute embolic infarcts


Diagnosis:

Left temporal biopsy revealed gram positive cocci in clusters consistent with abscess. Culture grew Strep milleri.

Discussion:

Restricted diffusion and elevated lactate with low NAA and choline favor brain abscess over metastases


Submitted by Kathleen Tozer, MD, UW Neuroradiology Fellow