Clinical question: History of Nocardia. Signs and symptoms: Fatigue. Pre- and post enhanced brain MRI:Examination demonstrates a well demarcated masslike lesion in the splenium of corpus callosal with intense uniform enhancement measuring at 18 x 16 x 22 mm. There is extensive associated vasogenic edema. The mass demonstrates multiple internal tiny foci of susceptibility.Additionally there are tiny foci of susceptibility and increased T2/FLAIR surrounding hyperintensity in the superior right aspect of pons which also demonstrate small ring enhancement however without any associated mass effect. Constellation of findings are greatest to represent intracranial manifestation of nocardia.Additionally there are multiple foci of susceptibility throughout bilateral cerebral hemispheres and to a lesser degree in the posterior fossa with a few of the larger lesions demonstrating ring enhancement as an example a lesion in the left frontal subcortical white matter measuring approximately 4 mm on axial post enhanced series 1001 image 19. These findings are also all highly suspected for nocardia infection.Ventricular system remain within normal size without deviation of midline and the cortical sulci remain patent. There are several small foci of FLAIR hyperintensity in the subcortical and periventricular white matter without enhancement and likely representing mild chronic small vessel ischemic strokes.Findings on this exam were discussed by phone with the referring clinical service Emily Escue # 2702 at the time of review of exam.
1.Negative diffusion weighted images.2.Extensive findings of intracranial manifestation of nocardia infection as detailed above. The largest lesion is in the splenium of corpus callosum measuring 18 x 16 x 22 mm. Multiple tiny additional lesions throughout bilateral cerebral hemispheres and minimally in the posterior fossa as detailed above.3.Mild findings of chronic small vessel ischemic strokes are noted. I