a) T2 weighted axial image displayed a hyperintense cortical signal alteration in two adjacent gyri of the left supplementary motor cortex (white arrow).b) This lesion was hyperintense in the axial diffusion weighted image (b = 1000 sec/mm2. Although it showed only minimally lowered ADC values (Apparent Diffusion Coefficient, black arrow, c), these findings were primarily consistent with an acute infarction. d) The index finger of his left hand showed a typical Janeway lesion highly indicative of a septic-embolic focus. Chest X-Ray (e) and computed tomography (f) showed a large fluid and air containing process in the right lower lobe consistent with a septic lung abscess. g) A computed tomography two days later revealed a now well demarcated lesion (native scan in axial orientation, black arrow). h) A further nine days later, after clinical deterioration a repeated scan revealed a large left frontal mass (native scan) with ring-like enhancement after i.v. administration of iodine contrast media (i). The findings were now typical for a brain abscess.
Albrecht et al. BMC Neurology 2012 12:133 doi:10.1186/1471-2377-12-133