Giant Cerebellar Lesion in a Patient With Purulent Ear Drainage

A woman in her 60s was evaluated in the neurosurgery intensive care unit for purulent discharge from her right ear. She had undergone an emergency craniotomy for brain decompression the day before. She was receiving intravenous antibiotics and steroids and was sedated and mechanically ventilated. Computed tomography (CT) of the temporal bone detected middle ear, mastoid, and infralabyrinthine involvement (Figure, A). Gadolinium-enhanced magnetic resonance imaging (MRI) of the brain demonstrated meningitis and a large cerebellar lesion with rim enhancement. Moreover, diffusionweighted imaging (DWI) images and apparent diffusion coefficient (ADC) maps were consistent with cerebellar abscess (Figure, B-D). Axial CT of the head A Axial T1-weighted MRI B