A 80 years old male patient came to neurology OPD with complaint of high grade fever, cognitive decline and behavioural disturbances 5 days back. No history of travelling / contact with any TB patient is seen. NCCT head was done and showed hypodense lesion with edema in left frontal lobe. MRI was done to characterize the lesion. Most likely diagnosis is-
Correct Answer: Pyogenic abscess
Description: MR showing a peripheral enhancing lesion in left frontal lobe showing diffusion restriction on DWI/ADC image. MRS is showing lipid lactate peak with amino acids peak. Most likely diagnosis is pyogenic abscess. T1- central low intensity (hyperintense to CSF), peripheral low intensity (vasogenic edema) T2/FLAIR- central high intensity (hypointense to CSF, does not attenuate on FLAIR) DWI/ADC- high DWI signal is usually present centrally represents true restricted diffusion MR spectroscopy: elevation of a succinate peak is relatively specific but not present in all abscesses; high lactate, acetate, alanine, valine, leucine, and isoleucine levels peak may be present; Cho/Crn and NAA peaks are reduced. Amino acids peak is not seen in tubercular abscess, GBM and hydatid cyst.
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