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Postgrad Med J 77:56 doi:10.1136/pmj.77.903.56
  • Self assessment answers

From confusion to coma: a catastrophic deterioration

Q1: What does figure 1 show and what is the differential diagnosis?

Figure 1 (p 52) shows a ring enhancing lesion with surrounding oedema in the left frontal lobe. Given the clinical features of pyrexia and also the raised white cell count, the most likely diagnosis is cerebral abscess. Other conditions to consider in the differential diagnosis include primary and secondary neoplasms.

Q2: How does figure 2 relate to the change in the patient's clinical condition?

Figure 2 (p 52) shows the abscess communicating and discharging, through a tract, into the ipselateral ventricle. Intraventricular rupture of an abscess is usually a catastrophic event leading to ventriculitis and dissemination of organisms throughout the cerebrospinal fluid pathway.1 This event accounts for the calamitous deterioration in the patient's clinical condition.

Q3: Discuss the management of this condition.

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