Can MRI differentiate between ring-enhancing gliomas and intra-axial abscesses?

Gliomas of the brain may appear as expansile ring-enhancing masses in MRI studies, mimicking the appearance of intra-axial abscesses. The aims of this study were to compare the MRI features of ring-enhancing gliomas and intra-axial brain abscesses in dogs and cats and to identify the characteristics that might help differentiate them. For this multicenter, retrospective, and observational study, the inclusion criteria were as follows: (a) a definitive diagnosis of glioma or abscess based on cytological or histopathological examination following CSF collection or surgical biopsy/necropsy, respectively; (b) MRI study performed with a high- or low-field MRI scanner, including a same plane T1W pre- and postcontrast, a T2W and a T2 FLAIR sequence in at least one plane. If available, delayed T1W postcontrast, T2*W GE, DWI/ADC, and SWI sequences were also evaluated. Sixteen patients were diagnosed with ring-enhancing gliomas, and 15 were diagnosed with intra-axial abscesses. A homogenous signal on T1W (P = 0.049) and T2W (P = 0.042) sequences, a T2W (P = 0.005) or T2*W GE (P = 0.046) peripheral hypointense halo, and an even enhancing capsule (P = 0.002) were significantly associated with brain abscesses. A progressive central enhancement on delayed T1W postcontrast sequences was correlated with ring-enhancing gliomas (P = 0.009). The combination of the following features was suggestive of brain abscess: homogeneous T1W or T2W signal intensity, a T2W or T2*W GE peripheral hypointense halo and an evenly enhancing capsule. Central progression of enhancement on delayed T1W postcontrast sequences was suggestive of glioma.

Intracranial abscess formation in an adult alpaca: a case report.

BACKGROUND: Intracranial abscess formation is an extremely rare and sporadically documented disease in South American Camelids (SACs). Herein we report the first case of otogenic brain abscess formation in this species. CASE PRESENTATION: A 4 years old female alpaca was presented to our veterinary hospital with a 6 month history of neurologic disorder symptoms, mainly head tilt to the right and emaciation. A comprehensive workup (ultrasound and computed tomography) revealed irreversible cranial nerve abnormalities, extensive lesions in the region of external, middle and internal right ear including destruction of bony structures (tympanic bulla, parts of temporal bone) and severe brain deformation caused by an intracranial abscess. The lesion was up to 6x7x4 cm and occupying almost 40% of the cranial cavity. No pathological findings were evident in other organs or structures. The late referral of the alpaca at this advanced stage of destructive disease precluded surgical intervention. CONCLUSIONS: This case report describes the clinical signs, diagnostic procedures and pathological findings in an adult female alpaca suffering from cranial nerve abnormalities caused by a massive otogenic brain abscess. Camelids suffering from otitis may not present with clinical signs until the pathology is severe. The importance of considering intracranial abscess formation as differential diagnosis in SACs showing the merest hint of nerve deficits cannot be emphasized enough in order to diagnose such pathological processes at an early and treatable stage.

Surgical management of a brain abscess due to plant foreign body in a dog.

Background: Intracranial abscesses as a result of grass awn migration have been rarely described in the veterinary literature. The identification of their radiological features is mandatory for proper diagnosis. As occurs with abscesses in other organs, surgical drainage and directed antibiotic therapy should be considered the treatment of choice. Case Description: A clinical case of a Great Dane dog with forebrain signs and magnetic resonance imaging and computed tomography findings compatible with intracranial abscess associated with inflammatory changes in orbital musculature is described. An exploratory rostro-tentorial craniotomy with durotomy was performed, allowing the drainage of purulent content and the extraction of a plant foreign body from the cerebral parenchyma. Antibiotic treatment was instituted and the patient was discharged without recurrence of neurological deficits other than quarterly seizures. Six months later, revision magnetic resonance was performed, revealing the resolution of the intracranial lesion and the normalization of the extracranial tissues. Conclusion: This is the first case in veterinary literature in which a grass awn has been surgically extracted from the brain of a dog with long-term outcome described. Observed changes in the extracranial musculature were fundamental to establish the pre-surgical diagnosis of a migratory foreign body.

Trueperella pyogenes isolated from a brain abscess of an adult roebuck (Capreolus capreolus).

The present study was designed to characterize phenotypically and genotypically a Trueperella pyogenes strain isolated from a brain abscess of an adult roebuck (Capreolus capreolus). The species identity could be confirmed by phenotypical investigations, by MALDI-TOF MS analysis, and by sequencing the 16S ribosomal RNA (rRNA) gene, the 16S-23S rRNA intergenic spacer region (ISR); by sequencing the target genes rpoB, gap, and tuf; and by detection of T. pyogenes chaperonin-encoding gene cpn60 with a previously developed loop-mediated isothermal amplification (LAMP) assay. The T. pyogenes strain could additionally be characterized by PCR-mediated amplification of several known and putative virulence factor-encoding genes which revealed the presence of the genes plo encoding pyolysin and nanH and nanP encoding neuraminidases; the genes fimA, fimC, and fimE encoding the fimbrial subunits FimA, FimC, and FimE; and the gene cbpA encoding collagen-binding protein CbpA. The present data give a detailed characterization of a T. pyogenes strain isolated from a brain abscess of a roebuck. However, the route of infection of the roebuck remains unclear.

Suppurative infectious diseases of the central nervous system in domestic ruminants / Doenças infecciosas supurativas do sistema nervoso central de ruminantes domésticos

This study describes suppurative infectious diseases of the central nervous system (CNS) in domestic ruminants of southern Brazil. Reports from 3.274 cattle, 596 sheep and 391 goats were reviewed, of which 219 cattle, 21 sheep and 7 goats were diagnosed with central nervous system inflammatory diseases. Suppurative infectious diseases of the CNS corresponded to 54 cases (28 cattle, 19 sheep and 7 goats). The conditions observed consisted of listerial meningoencephalitis (8 sheep, 5 goats and 4 cattle), suppurative leptomeningitis and meningoencephalitis (14 cattle, 2 goats and 1 sheep), cerebral (6 cattle and 2 sheep), and spinal cord (7 sheep) abscesses, and basilar empyema (4 cattle and 1 sheep). Bacterial culture identified Listeria monocytogenes (9/54 cases), Escherichia coli (7/54 cases), Trueperella pyogenes (6/54 cases) and Proteus mirabilis (1/54 cases). All cases diagnosed as listeriosis through histopathology yielded positive immunostaining on immunohistochemistry, while 12/17 of the cases of suppurative leptomeningitis and meningoencephalitis presented positive immunostaining for Escherichia coli. Meningoencephalitis by L. monocytogenes was the main neurological disease in sheep and goats, followed by spinal cord abscesses in sheep. In cattle, leptomeningitis and suppurative meningoencephalitis was the most frequent neurological disease for the species, and E. coli was the main cause of these lesions. Basilar empyema, mainly diagnosed in cattle, is related to traumatic injuries, mainly in the nasal cavity, and the main etiologic agent was T. pyogenes.(AU)

Neste trabalho são descritas as doenças neurológicas infecciosas supurativas de ruminantes domésticos na Região Sul do Brasil. Foram avaliados laudos de 3.274 bovinos, 596 ovinos e 391 caprinos, dos quais 219 bovinos, 21 ovinos e sete caprinos foram diagnosticados como doenças inflamatórias no sistema nervoso central. As doenças neurológicas infecciosas supurativas corresponderam a 54 casos (28 bovinos, 19 ovinos e sete caprinos). As enfermidades observadas foram meningoencefalite por Listeria monocytogenes (oito ovinos, cinco caprinos e quatro bovinos), leptomeningite e meningoencefalite supurativa (14 bovinos, dois caprinos e um ovino), abscessos cerebrais (seis bovinos e dois ovinos) e medulares (sete ovinos); e empiema basilar (quatro bovinos e um ovino). Através do isolamento bacteriano foram identificados: L. monocytogenes (9/54 casos), Echerichia coli (7/54 casos), Trueperella pyogenes (6/54 casos) e Proteus mirabilis (1/54 casos). Todos os casos diagnosticados como listeriose por histologia foram positivos na imuno-histoquímica para L. monocytogenes, e 12/17 casos de leptomeningite e meningoencefalite supurativa foram positivos na imuno-histoquímica para E. coli. A meningoencefalite por L. monocytogenes representou a principal enfermidade neurológica em ovinos e caprinos, seguido dos abscessos medulares em ovinos. A leptomeningite e meningoencefalite supurativa foi a doença neurológica supurativa mais frequente em bovinos e o principal agente causador da lesão foi E. coli. O empiema basilar, frequentemente, diagnosticado em bovinos, foi relacionado com lesões traumáticas, principalmente, de cavidade nasal e o principal agente causador foi T. pyogenes.(AU)

Computed tomographic findings and treatment of a bull with pituitary gland abscess.

BACKGROUND: In cattle, the prognosis of brain abscess is unfavourable and treatment is therefore not recommended. To the knowledge of the authors, there has been no report of successful treatment of a brain abscess in cattle.This report describes the clinical, computed tomographic and postmortem findings in a Holstein-Friesian bull with a hypophyseal abscess. CASE REPORT: The main clinical findings were generalised ataxia, ptyalism, prolapse of the tongue, dropped jaw, dysphagia, head tilt and unilateral ptosis. Cerebrospinal fluid evaluation revealed 2437 leukocytes/µl and severe pleocytosis. CT examination of the head showed a cavitary lesion consistent with an abscess in the hypophysis. Treatment consisted of gentamicin and flunixin meglumine for 3 days and amoxicillin for 40 days. The neurological signs resolved within 8 days of the start of treatment. The bull was slaughtered 11 months later because of infertility, and a postmortem examination was carried out. Histologically, a mild chronic non suppurative meningoencephalitis restricted to the ventral diencephalon was diagnosed. In addition, there was mild to moderate multifocal chronic lymphoplasmacytic hypophysitis with mild multifocal fibrosis. CONCLUSIONS: This case report stresses the significance of CT in confirming the clinical and laboratory diagnosis of central nervous system disorders in cattle and for localising brain lesions. Treatment of the brain abscess resulted, with respect to the central nervous disorder, in a successful outcome and was encouraging considering that most cases have an unfavourable prognosis.

Cerebral Candidal Abscess and Bovine Viral Diarrhoea Virus Infection in an Aborted Bovine Fetus.

Candida species are opportunistic fungi associated with immunosuppression and are the most commonly isolated fungal pathogens from the human central nervous system. Invasive candidiasis is reported uncommonly in animals and there have only been two reports of candidal infection of the brain. This report presents a case of a cerebral candidal abscess in an aborted late-term calf co-infected with bovine viral diarrhoea virus. Candida etchellsii, a species not previously identified as pathogenic, was identified as the causative agent by polymerase chain reaction.

Epethelial presence of Trueperella pyogenes predicts site-level presence of cranial abscess disease in white-tailed deer (Odocoileus virginianus).

Cranial/intracranial abscess disease is an emerging source of significant mortality for male white-tailed deer (Odocoileus virginianus). Most cases of cranial/intracranial abscess disease are associated with infection by the opportunistic pathogen Trueperella pyogenes although the relationship between the prevalence of the bacteria and occurrence of disease is speculative. We examined 5,612 hunter-harvested deer from 29 sites across all physiographic provinces in Georgia for evidence of cranial abscess disease and sampled the forehead, lingual, and nasal surfaces from 692 deer. We used polymerase chain reaction (PCR) to determine presence of T. pyogenes from these samples. We found T. pyogenes prevalence at a site was a predictor for the occurrence of cranial abscess disease. Prevalence of T. pyogenes did not differ between samples from the nose or tongue although prevalence along the forehead was greater for males than females (p = 0.04), particularly at sites with high occurrence of this disease. Socio-sexual behaviors, bacterial prevalence, or physiological characteristics may predispose male deer to intracranial/cranial abscess disease. Determination of factors that affect T. pyogenes prevalence among sites may help explain the occurrence of this disease among populations.

Cavernous sinus syndrome in a Holstein bull.

A 13-month-old Holstein bull was presented for right-sided exophthalmos. Ophthalmologic examination noted that the animal was visual in both eyes, but that the right pupil was persistently dilated and very sluggish to constrict when stimulated with a bright light and that normal ocular motility was absent. Fundic examination of the right eye was normal as was a complete ophthalmologic examination of the left eye. Radiographs at presentation did not reveal the presence of sinusitis or other skull abnormalities. Initial treatment comprised intravenous antibiotics and anti-inflammatories for orbital inflammation over a 14-day period. There was no perceptible change in the appearance or neuro-ophthalmologic examination of the right eye during hospitalization. The animal was discharged to the owner's care, but 3 weeks later was found recumbent with unilateral strabismus of the left eye and a fixed right pupil. Due to the inability to rise and rapid deterioration, humane euthanasia was performed, and a full postmortem examination, preceded by a MRI, was performed that identified abscesses extending bilaterally through the round foramina obliterating the cavernous sinus region, as well as abscessation of the right mandible, right trigeminal neuritis, right-sided sinusitis, and right-sided otitis media. Cavernous sinus syndrome should be considered in cattle with a combination of exophthalmos and neuro-ophthalmologic abnormalities involving cranial nerves III, IV, V, and VI, whose branches are located within the cavernous sinus.

Presumptive subdural empyema in a dog.

A 13 mo old mixed-breed dog was referred for acute lateralized forebrain signs. MRI of the brain demonstrated abnormalities consistent with severe meningitis and subdural empyema secondary to a retrobulbar abscess. The dog's clinical signs improved with antibiotic therapy, and repeat imaging showed resolution of subdural fluid accumulation presumed to be empyema with mild residual meningeal enhancement. Subdural empyema is an infrequent cause of encephalopathy in small animals and usually develops through direct extension of a pericranial infection. This report presents a case of presumptive subdural empyema in a dog that was successfully treated without surgical intervention. MRI is the preferred imaging modality for diagnosis of subdural empyema, and the characteristic imaging features are described.

Suppurative intracranial processes in 15 domestic ruminants / Processos supurativos intracranianos em 15 ruminantes domésticos

In addition to listeriosis which is relatively common in ruminants, there are three other uncommon suppurative intracranial processes (SIP) identifiable in adult ungulates as brain abscess, basilar empyema and suppurative meningitis. The present paper reports the epidemiological, clinical, laboratorial, pathological and microbiological findings of 15 domestic ruminants with SIP. A total of 15 animals were selected (eight sheep, four cattle and three goats); with the definitive diagnoses of basilar empyema (n=3), brain abscess (n=1), listeriosis (n=5) and suppurative meningitis (n=6). Hematology revealed leukocytosis with inversion of the lymphocyte/ neutrophil ratio in 4 cases. In the majority of animals, cerebrospinal fluid (CSF) presented light yellow coloration and cloudy aspect due to neutrophilic pleocytosis (15 - 997 leukocytes/µL). Microbiological culture of CSF or central nervous system (CNS) fragments resulted on isolation of Trueperella (Arcanobacterium) pyogenes,Listeria monocytogenes,Escherichia coli and Stenotrophomonas sp. In a goat with thalamic abscess, microbiological assay was not performed, but Gram positive bacilli type bacteria were observed in histology. The diagnosis of these outbreaks was based on the association of epidemiological, clinical, pathological and bacteriological findings; reiterating that the infectious component remains an important cause of CNS disease in domestic ruminants and also shows the need for dissemination of information about the most effective preventive measures for the ranchers.

Além da listeriose, que é relativamente comum em ruminantes, existem outros três processos supurativos intracranianos (PSI) identificáveis em ungulados adultos, que não são comuns, como: abscesso cerebral, empiema basilar e meningite supurativa. O presente trabalho tem como objetivo relatar os achados epidemiológicos, clínicos, laboratoriais, patológicos e microbiológicos de 15 ruminantes domésticos com PSI. O total de 15 animais foi selecionado (oito ovinos, quatro bovinos e três caprinos), com o diagnóstico definitivo de empiema basilar (n=3), abscesso cerebral (n=1), listeriose (n=5) e meningite supurativa (n=6). A hematologia revelou leucocitose com inversão da relação linfócito/ neutrófilo em quatro animais. Na maioria dos animais, a análise do líquido cefalorraquidiano (LCR) revelou coloração amarelado clara e aspecto turvo devido à pleocitose neutrofílica (15 - 997 leucócitos/µL). A cultura microbiológica de LCR ou de fragmentos do sistema nervoso central (SNC), permitiu o isolamento de Trueperella (Arcanobacterium) pyogenes,Listeria monocytogenes, Escherichia coli e Stenotrophomonas sp. No caprino com abscesso de tálamo, a cultura microbiológica não foi realizada, mas bactérias Gram positivas tipo bacilos foram observadas na histologia. O diagnóstico desses surtos foi baseado na associação dos achados epidemiológicos, clínicos, patológicos e bacteriológicos; reiterando que o componente infeccioso continua sendo uma causa importante de doença do SNC em ruminantes domésticos e também mostra a necessidade de disseminação da informação sobre as medidas preventivas mais eficazes para os criadores.

Imaging diagnosis--Conventional and functional magnetic resonance imaging of a brain abscess in a goat.

A 2-month-old female goat was presented for depressed mental status and multifocal central neurologic signs 3 weeks after hot-iron disbudding. Conventional magnetic resonance imaging (MRI) findings included a large intra axial mass in the left frontal lobe that was T2 hyperintense and T1 hypointense centrally with a contrast-enhancing peripheral capsule and perilesional T2 hyperintensity. A restrictive pattern was present in diffusion-weighted imaging. Magnetic resonance spectroscopy demonstrated an increased amount of succinate, acetate, amino acids, lipids; minimal amounts of lactate; and decreased amounts of N-acetyl aspartate and choline. A cerebral abscess due to Trueperella pyogenes was confirmed from necropsy and tissue culture.

Brain abscess in a rhesus macaque (Macaca mulatta) with a cephalic implant.

We report a case of brain abscess after craniotomy and the placement of a recording chamber for electrophysiologic records in an adult rhesus macaque (Macaca mulatta) enrolled in visual research. Approximately 2 wk after surgery, the macaque presented with nonspecific gastrointestinal signs and showed no evidence of fever, neurologic deficits, increased intracranial pressure, suggestive alterations in the CBC, or abnormal changes in the recording chamber. The macaque responded to symptomatic and antibiotic treatment and showed no behavioral or abnormal clinical signs for 3 wk before collapsing suddenly. The macaque was euthanized, and pathologic evaluation revealed a large brain abscess immediately under the original craniotomy.

Brain microabscesses in a porcine model of Staphylococcus aureus sepsis.

BACKGROUND: Sepsis caused by Staphylococcus aureus often leads to brain microabscesses in humans. Animal models of haematogenous brain abscesses would be useful to study this condition in detail. Recently, we developed a model of S. aureus sepsis in pigs and here we report that brain microabscesses develop in pigs with such induced S. aureus sepsis.Twelve pigs were divided into three groups. Nine pigs received an intravenous inoculation of S. aureus once at time 0 h (group 1) or twice at time 0 h and 12 h (groups 2 and 3). In each group the fourth pig served as control. The pigs were euthanized at time 12 h (Group 1), 24 h (Group 2) and 48 h (Group 3) after the first inoculation. The brains were collected and examined histopathologically. RESULTS: All inoculated pigs developed sepsis and seven out of nine pigs developed brain microabscesses. The microabscesses contained S. aureus and were located in the prosencephalon and mesencephalon. Chorioditis and meningitis occurred from 12 h after inoculation. CONCLUSIONS: Pigs with experimental S. aureus sepsis often develop brain microabscesses. The porcine brain pathology mirrors the findings in human sepsis patients. We therefore suggest the pig as a useful animal model of the development of brain microabscesses caused by S. aureus sepsis.

[Computed tomography diagnosis of a retrobulbar abscess in a white tiger]. / Computertomographische Diagnostik eines retrobulbären Abszesses bei einem weißen Königstiger.

SUBJECT: Etiologic diagnosis of a retrobulbar process is essential for the initiation of a causative therapy. Penetrating foreign bodies and tooth root abscesses, but also neoplastic processes have to be considered as a differential diagnosis for a retrobulbar swelling. The objective of this case report of a tiger with a retrobulbar process was to demonstrate the diagnostic value of computed tomography for making a causative diagnosis. MATERIAL AND METHODS: General examination of the tiger as well as subsequent computed tomography and surgical extraction of a fractured fourth premolar tooth of the left upper jaw was carried out under general anaesthesia. Collected alveolar tissue samples underwent cytological, histopathological and microbiological analyses. RESULTS AND CLINICAL RELEVANCE: Computed tomography was able to allocate the origin of the retrobulbar abscess to the left 4th premolar tooth of the upper jaw. The cytological, histopathological and microbiological examination of the recovered alveolar material confirmed the diagnosis of purulent-necrotic abscess-forming inflammation as a result of a mixed bacterial infection. The present case report demonstrates the diagnostic accuracy of computed tomography for the diagnosis of a retrobulbar process of unknown origin.

Fonsecaea multimorphosa sp. nov, a new species of Chaetothyriales isolated from a feline cerebral abscess.

A novel fungal species is described originating from the left occipital lobe of the cerebrum of an 18-month-old spayed female cat in Australia. Neurological disorder of the animal became apparent by circling movements and uncoordinated behaviour. Sequencing of the SSU rRNA gene reveals this strain as belonging to the genus Fonsecaea in Chaetothyriales. This order includes many black yeasts and relatives known as etiologic agents of disease in humans and animals, including several neurotropic species. Novelty of the species was corroborated by morphology and by multilocus sequencing of the ribosomal internal transcribed spacers (ITS) and partial sequences of the ß-tubulin (BT2) and translation elongation factor (TEF1) genes. The strain is very similar to several strains recovered by a selective isolation technique from the natural environment in Brazil.

Brain abscess in seven cats due to a bite wound: MRI findings, surgical management and outcome.

UNLABELLED: PRESENTATION AND LESION LOCALISATION: Seven adult domestic shorthair cats were presented with a 1- to 6-day history of progressive neurological signs. A focal skin puncture and subcutaneous swelling over the dorsal part of the head were detected on physical examination. Neurological examination indicated lesion(s) in the right forebrain in four cats, multifocal forebrain in one cat, left forebrain in one cat, and multifocal forebrain and brainstem in the remaining cat. In all cats, magnetic resonance imaging revealed a space-occupying forebrain lesion causing a severe mass effect on adjacent brain parenchyma. CLINICAL APPROACH AND OUTCOME: All cats were managed with a combination of medical and surgical treatment. At surgery a small penetrating calvarial fracture was detected in all cats, and a tooth fragment was found within the content of the abscess in two cats. The combination of surgical intervention, intensive care and intravenous antimicrobials led to a return to normal neurological function in five cats. PRACTICAL RELEVANCE: As this series of cases indicates, successful resolution of a brain abscess due to a bite injury depends on early recognition and combined used of antimicrobials and surgical intervention. A particular aim of surgery is to remove any skull and foreign body (tooth) fragments that may represent a continuing focus of infection.

Canine parvovirus type 2c infection in a kitten associated with intracranial abscess and convulsions.

A case of canine parvovirus type 2c (CPV-2c) infection in a 3-month-old feral kitten with a cerebral abscess and neurological disease is reported. The cat displayed ataxia and convulsions together with signs of gastroenteritis and profound alteration of the total and differential white blood cell counts. A parvovirus strain was detected by a TaqMan assay in the blood and faeces of the affected kitten, which was characterised as CPV by means of molecular assays but did not react with any of the CPV type-specific probes. By sequence and phylogenetic analyses of the VP2-protein gene, the CPV-2c strain displayed a non-coding mutation in the probe-binding region. Although the role of CPV-2c in this particular case is unclear, it is possible that it predisposed the kitten to the clinical signs seen. Continuous surveillance is needed to monitor future spreading of this CPV-2c mutant, and any associated clinical signs, in the dog and cat population.