Thread by @IUIDfellowship

#idboardreview 50 F recent dental infection presents 4d of fever, R headache, L weakness. MRI ring enhancing lesion & aspirate w/ GPC ‘balls of yarn’ 🧶 diagnosis? #medEd #idmedEd #IDtwitter

#streptococcus #anginosus species brain abscess from odontogenic source

MRI demonstrate a ring enhancing lesion in R frontal lobe with vivid central restricted diffusion. The enhancing component has a complete low T2 rim #brain abscess Ref: radiopaedia.org/cases/cerebral…

Gram stain reference asmscience.org/content/educat…

nejm.org/doi/pdf/10.105…

#brain abscess direct spread from a contiguous site usually causes a single brain abscess
-subacute/chronic OM & mastoiditis: to inferior temporal lobe & cerebellum
-frontal or ethmoid sinusitis:to frontal lobes
-dental infection: to frontal lobes

When focal sx present: LP is contraindicated due to risk of herniation. Dx MRI & Ct guided biopsy

Direct spread brain abscess: empiric ceftriaxone/metronidazole & adjust based on final micro. Duration 4-8 wks