A 43-year-old woman has had a headache and fever for the past 2 weeks following a severe respiratory tract infection accompanying bronchiectasis. On physical examination, her temperature is 38.3degC. There is no papilledema. She has no loss of sensation or motor function, but there is decreased vision in the left half of her visual fields. CT scan of the head shows a sharply demarcated, 3-cm, a ring-enhancing lesion in the right occipital region. A lumbar puncture is done, and laboratory analysis of the CSF shows numerous leukocytes, increased protein, and normal glucose levels. What is the most likely diagnosis?
A cerebral abscess is most often a complication of an infection, such as pneumonia or endocarditis, with onset days to weeks earlier. The bacteria spread hematogenously. As the abscess organizes, it is ringed by fibroblasts that deposit collagen; this feature is characteristic of an abscess in the CNS. A neoplasm occasionally may be ring-enhancing, but glioblastoma is an aggressive malignancy that is not well demarcated. Metastases are mass lesions that are typically multifocal. A multiple sclerosis plaques is generally not large, is found in white matter, and does not typically have ring enhancement. An infarct would produce sudden signs and symptoms that improve over time, and the CSF protein would not be increased.
Cerebral abscess
Glioblastoma
Metastatic carcinoma
Multiple sclerosis
Central Nervous System