Cerebral paragonimiasis, occurring as an extrapulmonary infestation, is one of the important intracranial lesions in Korea. In this paper we report a case of cerebral paragonimiasis which showed very similar C-T findings to pyogenic brain abscess and was verified by pathologic research. Though we don't have much experiences in the diagnosis of the cereal paragonimiasis with C-T Scan, we found out some differences between pyogenic abscess and that due to cerebral paragonimiasis in several aspects.
Abscess ; Brain Abscess* ; Brain* ; Edible Grain ; Diagnosis ; Korea ; Paragonimiasis*

PURPOSE: To analyze the imaging features of brain abscess. MATERIALS AND METHODS: MR studies of nine patients with surgically verified brain abscess were retrospectively reviewed. RESULTS: The shape of abscesses were round(n=6), multilobulated(n=2) or triangular(n=1). All lesions were located in corticomedullary junction and extended into white matter. On gadolinium-DTPA enhanced images, smooth rim-like(n=6) or irregular thick enhancement(n=3) of abscess wall was noted. Budlike projection from the abscess capsule was found in 4 cases. The signal intensity of abscess capsule was either hyperintense (n=5) or isointense(n=4) relative to white matter on Tl-weighted images, and hypointense(n=6), isointense (n=2) or mixed hypo and isointense(n=l) on T2-weighted images. Satellite nodules were found in 2 cases. PNS inflammation(n=2), meningitis(n=1), ventriculitis(=2) and subdural empyema(n=1) were associated CONCLUSION: The MR features of brain abscess included characteristic intensity of abscess capsule, budlike projection from the abscess wall, moderate amount of peripheral edema, satellite nodules, and associated meningitis, ventriculitis or PNS infection. The morphology of abscess wall was not specific for the diagnosis of brain abscess.
Abscess ; Brain Abscess* ; Brain* ; Diagnosis ; Edema ; Humans ; Meningitis ; Retrospective Studies

Eight patients, with brain abscess or localized cerebritis proved histologically, were seen at The National Medical Center from 1971 to 1972, and 3 died, which is 37.5% mortality. Evidence of infection was often minimal in patients with brain abscess. The presence of increased erythrocyte sedimentation rate, highly suggestive of a cerebral abscess when an intracranial space-occupying lesion is suspected. The cerebral angiography and EEG were the best diagnostic tests. Early accurate diagnosis and early intracranial relieving with surgical procedure were most important factor in management of brain abscess. Primary excision of the abscess was considered to be the most satisfactory therapy.
Abscess ; Blood Sedimentation ; Brain Abscess* ; Brain* ; Cerebral Angiography ; Diagnosis ; Diagnostic Tests, Routine ; Electroencephalography ; Humans ; Mortality

PURPOSE: The purpose of this study is to evaluate the CT and MR findings of brain absecss with emphasis on the thickeness and signal intensity of abscess wall. MATERIALS AND METHODS: Twenty CT scans and seven MR studies of 23 patients with brain abscess (27 abscesses) were retrospectively reviewed with respect to thickeness and signal intensity of abscess wall, shape and size of abscess, etc. Thickness of abscess wall was measured in the greatest abscess diameter on the CT scans and MR images obtaihed after intravenous administration of contrast material. RESULTS: Enhancing abscess wall was 2mm--6mm (average 3mm) thick. The abscess wall was uniform in thickness in 14 cases (52%), thinner in the roedial wall than lateral wall in 8 cases (30%), and thicker in the medial wall than lateral wall in 5 cases (18%). Signal intensity of abscess wall was isointense relative to gray matter on Tl-weighted MR images and hypointense on both proton- and T2-weighted MR images in 7 out of 8 lesione (88%). The inner margin of the abscess wall was smooth in 14 (52%) and irregular in 13 lesions (48%). The outer margin was smooth in 15 (55%) and irregular in 12 lesions (45%). The size of the abscesses was variable, ranging from lcm to 6cm in diameter. They were round (16 cases), elliptical (6 cases), or multilobulated (5 cases) in shape. Satellite or daughter abscesses were found in 5 patients. CONCLUSION: Abscess wall showed variable thickness in the medial and lateral walls with no specific findings. Other CT and MR findings were also nonspecific, although hypointensity of abscess wall on T2-weighted MR images may be helpful in diagnosis of brain abscess.
Abscess* ; Administration, Intravenous ; Brain Abscess* ; Brain* ; Diagnosis ; Humans ; Nuclear Family ; Retrospective Studies ; Tomography, X-Ray Computed

The use of CT is most reliable in diagnosis and management of brain abscess. Authors analized 17 cases of pathologically and clinically proven brain abscess during the period of 39 months from Jan. 1978 to Mar, 1982 at National Medical Center. The results were as follows; 1. The sex ration 9 males to 8 females, and no sexdifference was seen, and the greatest number of cases were seen below the age of 30(65%). 2. The otogenicinfection was the most frequent predisposing factors(8 cases). Other predisposing factors were postoperative infection (2 cases), pulmonary infection (2 cases), and congenital heart disease(2 cases). The most common site ofinvolvement was posterior fossa(5 cases). Next was temporal lobe (4 cases), and temporoparietal lobe (3 cases). 3.Most common presenting symptoms were headache, fever, focal neurological signs, and dizziness. 4. Among the 22 brain abscesses of 17 patients, the msot frequent CT finding in precontrast scan was a low density surrounded by afaint dense or dense ring (11 cases). Next was purely low density (6 cases). Associated hydrocephalus was found in4 cases, and multiple or multiloculated abscess was seen in 4 cases. 5. In post contrast scan, brain abscessusually show complete, oval or round shaped, thin, evening righ enhancement with mild or moderate surroundingedema, but there was no specific enhancement.
Abscess ; Brain Abscess ; Brain ; Causality ; Diagnosis ; Dizziness ; Female ; Fever ; Headache ; Heart ; Humans ; Hydrocephalus ; Male ; Temporal Lobe

"Peripheral ring enhancement" of intracranial lesions in the CT examination is still being considered as a specific manifestation for abscess or a cyst tumor. The author analysed 33 cases with peripheral ring enhancement and concluded that although most of brain abscesses, metastatic brain tumors and cystic astrocytomas might demonstrate it, it was not specific for any diseases. To reach the correct diagnosis, it is necessary to collect and analyse the clinical features, laboratory data, and follow-up CT in addition to present CT findings. Examples of the various types of lesions that demonstrate peripheral ring enhancement are shown. It is suggested that various pathology could demonstrate "ring enhancement lesion", if CT scan were done at a fortuitous time. Some differential diagnostic suggestions are also made.
Abscess ; Astrocytoma ; Brain Abscess ; Brain Neoplasms ; Diagnosis ; Follow-Up Studies ; Pathology ; Tomography, X-Ray Computed*

Sixty five intracranial abscesses were experienced from December , 1970 to August, 1981, of which fifty seven cases were operated. The clinical analysis and surgical experiences were summarized as follows. 1) The patients consisted of 45 male and 12 female and 31 patients(54.4%) were under 20 years of age. 2) Of the 57 patients, 45 patients(79%) had a demonstrable infectious source leading to the intracranial infection. There were 15 patients with ear infection and 13 patients with trauma. 3) Staphylococcus and streptococcus were the most common pathogens in this study. 4) Common symptoms of the patients were headache and fever, which were followed by mental disturbance and focal neurologic disturbance. 5) Brain CT scan offered accurate, non-invasive, rapid and easily repeatable means of diagnosis and following of lesions. After contrast infusion, ring enhancement had mostly thin and regular wall(88%). 6) The best operative methods of the brain abscess were aspiration and resection, or drainage and resection. The deep seated brain abscess, subdural abscess and epidural abscess could be treated using only drainage method with good results.
Abscess* ; Brain ; Brain Abscess ; Diagnosis ; Drainage ; Ear ; Epidural Abscess ; Female ; Fever ; Headache ; Humans ; Male ; Staphylococcus ; Streptococcus ; Tomography, X-Ray Computed

CNS infection due to Listeria monocytogenes is a rare condition that occurs primarily in immunocompromised patients. A predilection for the brainstem has been proposed but definite abscess formation is extremely rare. We report a case of necrotizing meningoencephalitis with diffuse extensive abscesses caused by Listeria monocytogenes in a chronic diabetic patient, whose diagnosis was based on blood culture and MRI findings.
Abscess ; Brain Abscess* ; Brain Stem ; Brain* ; Diagnosis ; Humans ; Immunocompromised Host ; Listeria monocytogenes* ; Listeria* ; Magnetic Resonance Imaging ; Meningoencephalitis

PURPOSE: To evaluate the usefulness of dynamic MR imaging in the differential diagnosis of intracranial tumorand abscess. MATERIALS AND METHODS: Dynamic MR images of 36 patients with surgically or clinically provenintracranial enhancing lesions were retrospectively reviewed. These lesions comprised 15 metastases, 14 gliomas,and seven abscesses. Images were sequentially obtained every 30 seconds for 3-5 minutes using the spin-echotechnique(TR/TE : 200 msec/15 msec) after bolus injection of gadolinium dimeglumine(2-3cc/sec). The dynamics ofcontrast enhancement of the lesions was analyzed visually and by calculating the sequential contrast-enhancementratio(CER). RESULTS: CER during the 30-second early dynamic phase was 93.16 in metastases, 67.78 in gliomas, and48.3 in abscesses(ANOVA, p<0.005). The contrast enhancement pattern of metastases showed rapidly increased signalintensity(SI) up to 30 seconds, followed by a relatively rapid decrease; less time was then required to reach theCER peak. In gliomas, SI increased gradually up to 180 seconds and then took a longer time to reach the CER peak.The SI of abscesses was similar to that of gliomas, with a more gradual increase for 30-60 seconds and a longertime for the CER peak to be reached. CONCLUSION: The contrast enhancement pattern and CER parameters seen ondynamic MRI can help differentiate intracranial tumor and abscess.
Abscess ; Brain Abscess* ; Brain Neoplasms* ; Brain* ; Diagnosis, Differential ; Gadolinium ; Glioma ; Humans ; Magnetic Resonance Imaging* ; Neoplasm Metastasis ; Retrospective Studies

The authors present a retrospective analysis of 100 consecutive patients who between February 1993 and June 1996 underwent computed tomography(CT)-guided stereotactic biopsy using the Riechert-Mundinger system. The patients were aged between ten and 70(mean 41) years and the male-to-female ratio was 58 : 42. All were suffering from intracranial lesion(s) which had not been correctly diagnosed by CT and/or magnetic resonance(MR) imaging. Among these 100 patients, 102 stereotactic biopsy procedures were carried out ; in two cases, the procedure was repeated, due to initial failure. Diagnostic yield was 92%(94 procedures) and the accuracy by image was 100%. After biopsy, eleven glioma cases underwent craniotomy ; in ten of these(92%), the diagnosis was the same on craniotomy and on biopsy. The exception had on biopsy been diagnosed as anaplastic astrocytoma, but on craniotomy was diagnosed as anaplastic oligoastrocytoma. The treatment plan for 27 of 85 patients(31%) was changed after biopsy. The mortality rate was 1%(one case) ; after biopsy, a patient with brain abscess and impending herniation died due to progressive brain edema. The morbidity rate was 7%(seven cases) ; one patient showed transient symptoms of increased intracranial pressure, five showed transient weakness, and one, transient speech disturbance. In conclusion, our system for CT-guided stereotactic biopsy is highly diagnostic, accurate, effective for treatment planning, and in diagnosing brain lesions, does not damage tissue. The possible causes and the solutions for non-specific diagnoses are also discussed.
Astrocytoma ; Biopsy* ; Brain Abscess ; Brain Edema ; Brain* ; Craniotomy ; Diagnosis ; Glioma ; Humans ; Intracranial Pressure ; Mortality ; Retrospective Studies