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Brain abscesses are less common than brain tumours buttheir frequency has increased over the past decade as a result ofAIDS and a rising number of immunocompromised patients12
Abscesses are usually solitary in the frontal or parietal lobe ofvariable size and develop by contagious spread Multipleabscesses are usually related to pulmonary and dental infectionsand arise from hematogeneous dissemination1 Multipleabscesses are serious neurological problems with high mortalityand disabling morbidity in survivors34 The causative pathogensof bacterial brain abscess vary with geographic distribution ageunderlying medical and surgical conditions and mode ofinfection4 Reports on brain or spinal abscesses caused byFusobacterium nucleatum are uncommon4-6 Recently we caredfor a patient with multiple brain abscesses due to Fusobacterium
ABSTRACT Background Multiple brain abscesses are serious neurological problems with highmortality and disabling morbidity The frequency is rising as a result of AIDS and the increasing numberof immunocompromised patients Case study A 59-year-old woman developed signs and symptoms ofdiffuse brain dysfunction including fever and neck stiffness A brain CT scan demonstrated ninecontrast-enhancing ring-shaped lesions Analysis of the cerebrospinal fluid using PCR-techniquerevealed DNA of Fusobacterium nucleatum Conservative treatment with antibiotics was successfulThe patient recovered with only mild cognitive deficits Results The experience of our patient and thereview of the literature indicate that multiple brain abscesses due to Fusobacterium nucleatum are rareThe most probable source is oral infection Conclusion Multiple brain abscesses may be caused byFusobacterium nucleatum Cerebrospinal fluid analysis using PCR technique is helpful with diagnosisConservative management can be successful
REacuteSUMEacute Traitement conservateur des abcegraves ceacutereacutebraux multiples causeacutes par Fusobacterium nucleatumIntroduction Les abcegraves ceacutereacutebraux multiples constituent toujours un problegraveme neurologique seacuterieux comportant untaux de mortaliteacute eacuteleveacute et une morbiditeacute seacutevegravere Leur freacutequence augmente dans le contexte de lrsquoeacutepideacutemie du SIDAet du nombre croissant de patients immunocompromis Eacutetude de cas Une femme acircgeacutee de 59 ans a preacutesenteacute dessignes de dysfonction ceacutereacutebrale diffuse accompagneacutes drsquohyperthermie et de raideur de la nuque Latomodensitomeacutetrie ceacutereacutebrale a mis en eacutevidence la preacutesence de neuf leacutesions annulaires rehaussantes Lrsquoanalyse duliquide ceacutephalo-rachidien (LCR) au moyen de la technique de lrsquoamplification en chaicircne par polymeacuterase (PCR) areacuteveacuteleacute la preacutesence drsquoADN du Fusobacterium nucleatum Le traitement conservateur par antibiotiques a eacuteteacute efficaceet la patiente ne preacutesentait comme seacutequelle que de leacutegers deacuteficits cognitifs Reacutesultats Ce cas ainsi que la revue dela litteacuterature indiquent que les abcegraves ceacutereacutebraux multiples dus au Fusobacterium nucleatum sont rares La sourcedrsquoinfection la plus probable est une infection orale Conclusions Des abcegraves ceacutereacutebraux multiples peuvent ecirctre causeacutespar le Fusobacterium nucleatum Lrsquoanalyse du LCR par la technique de la PCR peut aider au diagnostic Letraitement conservateur peut ecirctre efficace
Can J Neurol Sci 2003 30 266-268
266 THE CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES
Multiple Brain Abscesses Caused byFusobacterium nucleatum TreatedConservativelyJosef G Heckmann Christoph JG Lang Heinz Hartl Bernd Tomandl
From the Deptartments of Neurology (JGH CJGL HH) and Neuroradiology (BT)University Hospital Erlangen-Nuremberg Germany
RECEIVED AUGUST 20 2002 ACCEPTED IN FINAL FORM DECEMBER 9 2002Reprint requests to Josef G Heckmann Dept of Neurology University HospitalErlangen-Nuremberg Schwabachanlage 6 91054 Erlangen Germany
CASE REPORT
nucleatum and conservative treatment resulted in clinicalrecovery with only mild cognitive deficits
CASE REPORT
A 59-year-old woman was found confused in her home There was ahistory of moderate ethanol (three cans of beer a day) use On admission
httpsdoiorg101017S0317167100002717Downloaded from httpswwwcambridgeorgcore IP address 541914080 on 20 Apr 2017 at 151947 subject to the Cambridge Core terms of use available at httpswwwcambridgeorgcoreterms
LE JOURNAL CANADIEN DES SCIENCES NEUROLOGIQUES
Volume 30 No 3 ndash August 2003 267
she was disorientated and suffering from marked neck stiffness Herbody temperature had risen to 387degC The neurological examination didnot show focal abnormalities Contrast enhanced computed tomography(CT) of the head (Figure) revealed nine ring-shaped enhancing lesions
Lumbar puncture showed granulocytic pleocytosis (32000 whitecellscu mm normal lt4) elevated protein (598 gL normal lt05gL)elevated lactate (15 mmolL normal 11-21 mmolL) and decreasedglucose (lt1 normal gt40) Microbiological studies of the CSF usingPCR technique demonstrated DNA of Fusobacterium nucleatum Bloodand CSF cultures were negative The only predisposing factor in thepatientrsquos history was moderate alcohol consumption Tests for diabetesmellitus and HIV infection were negative Ceftriaxon 2g dailyfosfomycin 3x3g daily and metronidazol 3x05g daily wereadministered for four weeks In addition dexamethasone (3x3g daily)was administered to treat brain edema for ten days Neurosurgicalstereotactic aspiration and drainage was discussed initially but discardedbecause of rapid neurological clinical improvement Transesophagealechocardiography CT of thorax and abdomen and otolaryngealconsultation did not show any source of infection Dental examinationrevealed a poor dental hygiene but there were no recent dental
infections The patient improved but intercurrent nosocomialbronchopneumonia required ciprofloxacin (2x04g daily for ten days)and transient mechanical ventilation for four days The patient laterreceived rehabilitation and recovered with only mild cognitive deficits(impaired attention and memory)
DISCUSSION
Despite the demarcation of nine abscesses on the CT scanincluding one prominent one in the brainstem our patientshowed only signs and symptoms of diffuse brain dysfunctionand no focal neurological deficits Thus only two of the typicaltriad1 (headache fever focal neurologic dysfunction) werepresent Further differential diagnosis for multiple ring-shapedenhancing lesions includes primary and secondary tumors otherinfectious etiologies such as fungal and parasitic infectionsresolving cerebral hemorrhage radiation necrosisgranulomatous processes and inflammatory demyelinatingdiseases (see Table)78 These were excluded in our patient byhistory and adjuvant laboratory studies
Microbiological cultures of the CSF and blood were negative
Figure Axial contrast enhanced CT demonstrates multiple ring-enhancing lesions
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THE CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES
268
Using PCR DNA of anaerobic Fusobacterium nucleatum wasidentified as the most probable causative organims in CSFAnaerobic isolates are encountered with increasing frequencybut solitary Fusobacterium nucleatum is rarely identified159
Despite this we did not find the infectious source and assumedthat there was an underlying orofacial infection due to the poordental health of the patient Fusobacterium nucleatum belongs tothe family of Bacteroidaceae The term is derived from the Latinword fusus referring to its spindle-shaped appearance Thegerm is nonsporeforming nonmotile gram-negative and mainlyanaerobic10 Its pathogenic potential has gained significance inthe development of periodontal diseases and in particular inorofacial infections1011 Infection of other organs such as liverlung heart and central nervous system caused by Fusobacteriumnucleatum are very rare5611-14
Conservative treatment in our patient using antibiotics andsteroids was successful Nevertheless the optimal treatment ofbrain abscesses is still a matter for debate Proposed treatmentregimens are either antibiotics alone or in combination withstereotactic aspiration and craniotomy for excision15 Thegeneral consensus has been that solitary abscesses that can besafely approached neurosurgically should be treated stereo-tactically with aspiration possibly combined with drainage andsystemic antibiotics415-17 Multiple abscesses small abscessesearly stage of cerebritis or abscesses in an unfavourable locationwarrant conservative treatment perhaps combined withstereotactic drainage and to identify the causative organism1518
REFERENCES
1 Case 43-1993 N Engl J Med 19933291335-1341 2 Calfee DP Wispelwey B Brain abscess Semin Neurol
200020353-3603 Sotelo J Commentary on the article - Mutiple brain abscesses
caused by Salmonella typhi case report Surg Neurol20005386-90
4 Lu CH Chang WN Lin YC et al Bacterial brain abscessmicrobiological features epidemiological trends and therapeuticoutcomes Q J Med 200295501-509
5 Taguchi Y Sato J Nakamura N Gas-containing brain abscess dueto Fusobacterium nucleatum Surg Neurol 198116408-410
6 Recagno G Borda N Placenzotti C Jairala D Notario R Spinalepidural abscess due to Fusobacterium nucleatum Medicina (BAires) 199757720-722 [in Spanish]
7 Grumme T Kluge W Kretzschmar K Roesler A Zerebrale undSpinale Computertomographie Berlin Wien BlackwellWissenschafts-Verlag 1998 [in German]
8 Solbrig MV Healy JF Jay CA Bacterial infections In BradleyWG Daroff RB Fenichel GM Marsden CD (Eds) Neurology inClinical Practice third ed Boston Butterworth Heinemann2000 1317-1351
9 Chaudry R Dhawan B Laxmi BV Mehta VS The microbialspectrum of brain abscesses with special reference to anaerobicbacteria Br J Neurosurg 199812127-130
10 Bolstad AI Jensen HB Bakken V Taxonomy biology andperiodontal aspects of Fusobacterium nucleatum Clin MicrobiolRev 1996955-71
11 Roberts GL Fusobacterium infections an underestimated threat BrJ Biomed Sci 200057156-162
12 Memain N Arvaniti K Bruneel F et al Septic shock with liverabscess in an immunocompetent patient Presentation of anunusual Fusobacterium nucleatum infection Presse Med2001301777-1779 [in French]
13 Brook I Clinical review bacteremia caused by anaerobic bacteriain children Crit Care 20026205-211
14 Shammas NW Murphy GW Eichelberger J et al Infectiveendocarditis due to Fusobacterium nucleatum case report andreview of the literature Clin Cardiol 19931672-75
15 Shahzadi S Lozano AM Bernstein M Guha A Tasker RRStereotactic management of bacterial brain abscesses Can JNeurol Sci 199623343-349
16 Schielke E Bacterial brain abscess Nervenarzt 199566745-753[in German]
17 Bidzinski J Koszewski W The value of different methods oftreatment of brain abscess in the CT era Acta Neurochir (Wien)1990105117-120
18 Wispelwey B Brain abscesses In Mandell GL Bleck TP (Eds)Atlas of Infectious Diseases Volume III Central Nervous Systemand Eye Infections Philadelphia Churchill Livingstone 199541-416
19 Roda JM Carceller F Perez-Higueras A Morales C Encapsulatedintracerebral hematomas a defined entity Case report JNeurosurg 199378829-833
Table Differential diagnosis of multiple brain abscesses (modified from Grumme et al7 Solbrig et al8 and Roda et al19)
Differential diagnosis Notations CT-findings Abscesses multiple abscesses Space-occupying perifocal edema mostly with small contrast enhancing
ring ring of enhancement often thicker near the cortex and thinner near theventricle blood-borne abscesses often found at grey and white matterjunctions in the territory of the middle cerebral artery
Other infectious etiologies which mimic multiple abscesses Subdural empyema epidural abscess viral encephalitis bacterial or acuteaseptic meningitis endocarditis with septic embolism fungal and parasiticinfections
Primary or metastatic brain tumours (eg glioblastoma lymphoma) Space-occupying perifocal edema mostly with broad contrast enhancingring
Encapsulated hematoma Encapsulated hematoma with ring of contrast enhancement and perifocaledema usually caused by vascular malformation
Granulomas Tuberculoma gumma sarcoidosisRadiation necrosis History of radiationDemyelinating diseases Tumour-like lesion with enhancement in multiple sclerosis (MS) or in
progressive multifocal leukoencephalopathy
httpsdoiorg101017S0317167100002717Downloaded from httpswwwcambridgeorgcore IP address 541914080 on 20 Apr 2017 at 151947 subject to the Cambridge Core terms of use available at httpswwwcambridgeorgcoreterms
LE JOURNAL CANADIEN DES SCIENCES NEUROLOGIQUES
Volume 30 No 3 ndash August 2003 267
she was disorientated and suffering from marked neck stiffness Herbody temperature had risen to 387degC The neurological examination didnot show focal abnormalities Contrast enhanced computed tomography(CT) of the head (Figure) revealed nine ring-shaped enhancing lesions
Lumbar puncture showed granulocytic pleocytosis (32000 whitecellscu mm normal lt4) elevated protein (598 gL normal lt05gL)elevated lactate (15 mmolL normal 11-21 mmolL) and decreasedglucose (lt1 normal gt40) Microbiological studies of the CSF usingPCR technique demonstrated DNA of Fusobacterium nucleatum Bloodand CSF cultures were negative The only predisposing factor in thepatientrsquos history was moderate alcohol consumption Tests for diabetesmellitus and HIV infection were negative Ceftriaxon 2g dailyfosfomycin 3x3g daily and metronidazol 3x05g daily wereadministered for four weeks In addition dexamethasone (3x3g daily)was administered to treat brain edema for ten days Neurosurgicalstereotactic aspiration and drainage was discussed initially but discardedbecause of rapid neurological clinical improvement Transesophagealechocardiography CT of thorax and abdomen and otolaryngealconsultation did not show any source of infection Dental examinationrevealed a poor dental hygiene but there were no recent dental
infections The patient improved but intercurrent nosocomialbronchopneumonia required ciprofloxacin (2x04g daily for ten days)and transient mechanical ventilation for four days The patient laterreceived rehabilitation and recovered with only mild cognitive deficits(impaired attention and memory)
DISCUSSION
Despite the demarcation of nine abscesses on the CT scanincluding one prominent one in the brainstem our patientshowed only signs and symptoms of diffuse brain dysfunctionand no focal neurological deficits Thus only two of the typicaltriad1 (headache fever focal neurologic dysfunction) werepresent Further differential diagnosis for multiple ring-shapedenhancing lesions includes primary and secondary tumors otherinfectious etiologies such as fungal and parasitic infectionsresolving cerebral hemorrhage radiation necrosisgranulomatous processes and inflammatory demyelinatingdiseases (see Table)78 These were excluded in our patient byhistory and adjuvant laboratory studies
Microbiological cultures of the CSF and blood were negative
Figure Axial contrast enhanced CT demonstrates multiple ring-enhancing lesions
httpsdoiorg101017S0317167100002717Downloaded from httpswwwcambridgeorgcore IP address 541914080 on 20 Apr 2017 at 151947 subject to the Cambridge Core terms of use available at httpswwwcambridgeorgcoreterms
THE CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES
268
Using PCR DNA of anaerobic Fusobacterium nucleatum wasidentified as the most probable causative organims in CSFAnaerobic isolates are encountered with increasing frequencybut solitary Fusobacterium nucleatum is rarely identified159
Despite this we did not find the infectious source and assumedthat there was an underlying orofacial infection due to the poordental health of the patient Fusobacterium nucleatum belongs tothe family of Bacteroidaceae The term is derived from the Latinword fusus referring to its spindle-shaped appearance Thegerm is nonsporeforming nonmotile gram-negative and mainlyanaerobic10 Its pathogenic potential has gained significance inthe development of periodontal diseases and in particular inorofacial infections1011 Infection of other organs such as liverlung heart and central nervous system caused by Fusobacteriumnucleatum are very rare5611-14
Conservative treatment in our patient using antibiotics andsteroids was successful Nevertheless the optimal treatment ofbrain abscesses is still a matter for debate Proposed treatmentregimens are either antibiotics alone or in combination withstereotactic aspiration and craniotomy for excision15 Thegeneral consensus has been that solitary abscesses that can besafely approached neurosurgically should be treated stereo-tactically with aspiration possibly combined with drainage andsystemic antibiotics415-17 Multiple abscesses small abscessesearly stage of cerebritis or abscesses in an unfavourable locationwarrant conservative treatment perhaps combined withstereotactic drainage and to identify the causative organism1518
REFERENCES
1 Case 43-1993 N Engl J Med 19933291335-1341 2 Calfee DP Wispelwey B Brain abscess Semin Neurol
200020353-3603 Sotelo J Commentary on the article - Mutiple brain abscesses
caused by Salmonella typhi case report Surg Neurol20005386-90
4 Lu CH Chang WN Lin YC et al Bacterial brain abscessmicrobiological features epidemiological trends and therapeuticoutcomes Q J Med 200295501-509
5 Taguchi Y Sato J Nakamura N Gas-containing brain abscess dueto Fusobacterium nucleatum Surg Neurol 198116408-410
6 Recagno G Borda N Placenzotti C Jairala D Notario R Spinalepidural abscess due to Fusobacterium nucleatum Medicina (BAires) 199757720-722 [in Spanish]
7 Grumme T Kluge W Kretzschmar K Roesler A Zerebrale undSpinale Computertomographie Berlin Wien BlackwellWissenschafts-Verlag 1998 [in German]
8 Solbrig MV Healy JF Jay CA Bacterial infections In BradleyWG Daroff RB Fenichel GM Marsden CD (Eds) Neurology inClinical Practice third ed Boston Butterworth Heinemann2000 1317-1351
9 Chaudry R Dhawan B Laxmi BV Mehta VS The microbialspectrum of brain abscesses with special reference to anaerobicbacteria Br J Neurosurg 199812127-130
10 Bolstad AI Jensen HB Bakken V Taxonomy biology andperiodontal aspects of Fusobacterium nucleatum Clin MicrobiolRev 1996955-71
11 Roberts GL Fusobacterium infections an underestimated threat BrJ Biomed Sci 200057156-162
12 Memain N Arvaniti K Bruneel F et al Septic shock with liverabscess in an immunocompetent patient Presentation of anunusual Fusobacterium nucleatum infection Presse Med2001301777-1779 [in French]
13 Brook I Clinical review bacteremia caused by anaerobic bacteriain children Crit Care 20026205-211
14 Shammas NW Murphy GW Eichelberger J et al Infectiveendocarditis due to Fusobacterium nucleatum case report andreview of the literature Clin Cardiol 19931672-75
15 Shahzadi S Lozano AM Bernstein M Guha A Tasker RRStereotactic management of bacterial brain abscesses Can JNeurol Sci 199623343-349
16 Schielke E Bacterial brain abscess Nervenarzt 199566745-753[in German]
17 Bidzinski J Koszewski W The value of different methods oftreatment of brain abscess in the CT era Acta Neurochir (Wien)1990105117-120
18 Wispelwey B Brain abscesses In Mandell GL Bleck TP (Eds)Atlas of Infectious Diseases Volume III Central Nervous Systemand Eye Infections Philadelphia Churchill Livingstone 199541-416
19 Roda JM Carceller F Perez-Higueras A Morales C Encapsulatedintracerebral hematomas a defined entity Case report JNeurosurg 199378829-833
Table Differential diagnosis of multiple brain abscesses (modified from Grumme et al7 Solbrig et al8 and Roda et al19)
Differential diagnosis Notations CT-findings Abscesses multiple abscesses Space-occupying perifocal edema mostly with small contrast enhancing
ring ring of enhancement often thicker near the cortex and thinner near theventricle blood-borne abscesses often found at grey and white matterjunctions in the territory of the middle cerebral artery
Other infectious etiologies which mimic multiple abscesses Subdural empyema epidural abscess viral encephalitis bacterial or acuteaseptic meningitis endocarditis with septic embolism fungal and parasiticinfections
Primary or metastatic brain tumours (eg glioblastoma lymphoma) Space-occupying perifocal edema mostly with broad contrast enhancingring
Encapsulated hematoma Encapsulated hematoma with ring of contrast enhancement and perifocaledema usually caused by vascular malformation
Granulomas Tuberculoma gumma sarcoidosisRadiation necrosis History of radiationDemyelinating diseases Tumour-like lesion with enhancement in multiple sclerosis (MS) or in
progressive multifocal leukoencephalopathy
httpsdoiorg101017S0317167100002717Downloaded from httpswwwcambridgeorgcore IP address 541914080 on 20 Apr 2017 at 151947 subject to the Cambridge Core terms of use available at httpswwwcambridgeorgcoreterms
THE CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES
268
Using PCR DNA of anaerobic Fusobacterium nucleatum wasidentified as the most probable causative organims in CSFAnaerobic isolates are encountered with increasing frequencybut solitary Fusobacterium nucleatum is rarely identified159
Despite this we did not find the infectious source and assumedthat there was an underlying orofacial infection due to the poordental health of the patient Fusobacterium nucleatum belongs tothe family of Bacteroidaceae The term is derived from the Latinword fusus referring to its spindle-shaped appearance Thegerm is nonsporeforming nonmotile gram-negative and mainlyanaerobic10 Its pathogenic potential has gained significance inthe development of periodontal diseases and in particular inorofacial infections1011 Infection of other organs such as liverlung heart and central nervous system caused by Fusobacteriumnucleatum are very rare5611-14
Conservative treatment in our patient using antibiotics andsteroids was successful Nevertheless the optimal treatment ofbrain abscesses is still a matter for debate Proposed treatmentregimens are either antibiotics alone or in combination withstereotactic aspiration and craniotomy for excision15 Thegeneral consensus has been that solitary abscesses that can besafely approached neurosurgically should be treated stereo-tactically with aspiration possibly combined with drainage andsystemic antibiotics415-17 Multiple abscesses small abscessesearly stage of cerebritis or abscesses in an unfavourable locationwarrant conservative treatment perhaps combined withstereotactic drainage and to identify the causative organism1518
REFERENCES
1 Case 43-1993 N Engl J Med 19933291335-1341 2 Calfee DP Wispelwey B Brain abscess Semin Neurol
200020353-3603 Sotelo J Commentary on the article - Mutiple brain abscesses
caused by Salmonella typhi case report Surg Neurol20005386-90
4 Lu CH Chang WN Lin YC et al Bacterial brain abscessmicrobiological features epidemiological trends and therapeuticoutcomes Q J Med 200295501-509
5 Taguchi Y Sato J Nakamura N Gas-containing brain abscess dueto Fusobacterium nucleatum Surg Neurol 198116408-410
6 Recagno G Borda N Placenzotti C Jairala D Notario R Spinalepidural abscess due to Fusobacterium nucleatum Medicina (BAires) 199757720-722 [in Spanish]
7 Grumme T Kluge W Kretzschmar K Roesler A Zerebrale undSpinale Computertomographie Berlin Wien BlackwellWissenschafts-Verlag 1998 [in German]
8 Solbrig MV Healy JF Jay CA Bacterial infections In BradleyWG Daroff RB Fenichel GM Marsden CD (Eds) Neurology inClinical Practice third ed Boston Butterworth Heinemann2000 1317-1351
9 Chaudry R Dhawan B Laxmi BV Mehta VS The microbialspectrum of brain abscesses with special reference to anaerobicbacteria Br J Neurosurg 199812127-130
10 Bolstad AI Jensen HB Bakken V Taxonomy biology andperiodontal aspects of Fusobacterium nucleatum Clin MicrobiolRev 1996955-71
11 Roberts GL Fusobacterium infections an underestimated threat BrJ Biomed Sci 200057156-162
12 Memain N Arvaniti K Bruneel F et al Septic shock with liverabscess in an immunocompetent patient Presentation of anunusual Fusobacterium nucleatum infection Presse Med2001301777-1779 [in French]
13 Brook I Clinical review bacteremia caused by anaerobic bacteriain children Crit Care 20026205-211
14 Shammas NW Murphy GW Eichelberger J et al Infectiveendocarditis due to Fusobacterium nucleatum case report andreview of the literature Clin Cardiol 19931672-75
15 Shahzadi S Lozano AM Bernstein M Guha A Tasker RRStereotactic management of bacterial brain abscesses Can JNeurol Sci 199623343-349
16 Schielke E Bacterial brain abscess Nervenarzt 199566745-753[in German]
17 Bidzinski J Koszewski W The value of different methods oftreatment of brain abscess in the CT era Acta Neurochir (Wien)1990105117-120
18 Wispelwey B Brain abscesses In Mandell GL Bleck TP (Eds)Atlas of Infectious Diseases Volume III Central Nervous Systemand Eye Infections Philadelphia Churchill Livingstone 199541-416
19 Roda JM Carceller F Perez-Higueras A Morales C Encapsulatedintracerebral hematomas a defined entity Case report JNeurosurg 199378829-833
Table Differential diagnosis of multiple brain abscesses (modified from Grumme et al7 Solbrig et al8 and Roda et al19)
Differential diagnosis Notations CT-findings Abscesses multiple abscesses Space-occupying perifocal edema mostly with small contrast enhancing
ring ring of enhancement often thicker near the cortex and thinner near theventricle blood-borne abscesses often found at grey and white matterjunctions in the territory of the middle cerebral artery
Other infectious etiologies which mimic multiple abscesses Subdural empyema epidural abscess viral encephalitis bacterial or acuteaseptic meningitis endocarditis with septic embolism fungal and parasiticinfections
Primary or metastatic brain tumours (eg glioblastoma lymphoma) Space-occupying perifocal edema mostly with broad contrast enhancingring
Encapsulated hematoma Encapsulated hematoma with ring of contrast enhancement and perifocaledema usually caused by vascular malformation
Granulomas Tuberculoma gumma sarcoidosisRadiation necrosis History of radiationDemyelinating diseases Tumour-like lesion with enhancement in multiple sclerosis (MS) or in
progressive multifocal leukoencephalopathy
httpsdoiorg101017S0317167100002717Downloaded from httpswwwcambridgeorgcore IP address 541914080 on 20 Apr 2017 at 151947 subject to the Cambridge Core terms of use available at httpswwwcambridgeorgcoreterms
![Case Report Pelvic Primary Staphylococcal Infection ... · as abscesses in extra-abdominal locations [ ], including the ... psoas abscesses require correction of their underlying](https://img.pdfslide.us/doc/110x75/60f8ba0797237226e569ae63/case-report-pelvic-primary-staphylococcal-infection-as-abscesses-in-extra-abdominal.jpg)
