ABSCESS IN BRAIN WITH MINIMAL SIGNS OF PURLENT MENINGITIS
The patient developed a "cold" and was treated with antibiotics. He became withdrawn, unco-operative and difficult to manage. O/E hepatomegaly, right ankle clonus. LP showed cloudy CSF and streptococcus pyogenes was cultured. EEG and brain scan did not support ruptured intracerebral abscess. Patient died 2 days after admission.
The specimen consists of a coronal section through brain showing an irregular cavity in the basal ganglia on the right-hand side. The base of the cavity is ragged but no pus is visible. The cavity appears to have burst into the ventricular system. The left parieto-temporal groove shows a collection of pale greenish material and the adjacent meninges are hazy. It is most probable that the cerebral abscess was first to occur and the meningitis was secondary.