Uncertainties Volume I by Brian J. Showers

Generally, causes that could explain cardiac embolism to the brain are 1: Given the known aortic root abscess, this was considered the most likely source, and, although no other imaging features to suggest an abscess or a mycotic aneurysm, septic emboli was strongly considered. The imaging appearances of multiple infarcts in almost all the major vascular territories, including the posterior fossa, are those of shower emboli from a central source. This patient went to further formal DSA angiography, which also came as normal. Within the motion degraded MRA (not shown), no vascular abnormalities were seen, in particular, no evidence of a mycotic aneurysm. No convincing mycotic aneurysm within limitations of the motion degraded MRA. MRA time-of-flight, although motion degraded, appears overall unremarkable when correlated to the previous CTA, with no evidence of acute abnormalities or convincing vasoconstriction (not shown).Ĭonclusion: Embolic shower throughout the supra and infratentorial brain is likely septic in nature given the stated aortic root abscess. The remainder of the brain, the ventricles, and basal cisterns appear unremarkable. A small focus of susceptibility artefact in the right frontal lobe may represent micro-hemorrhage or a small cavernoma. The appearances are not of the suspected venous thrombosis. These demonstrate increased T2 and FLAIR signal and, although no definitive collection is appreciated within these small lesions, in this clinical scenario, septic emboli is the most favored diagnosis. There are multiple small foci of diffusion restriction scattered throughout the brain parenchyma within all the major vascular territories, including the brainstem and cerebellar hemispheres.

Uncertainties Volume I by Brian J. Showers