A 27 years old man, presented with complaints fever, headache and seizures

A 27 years old man, presented with complaints fever, headache and seizures

A 27 year old man, presented with complaints of fever, headache, and seizures

Fluid-filled opacification of left middle ear cavity and mastoid antrum showing diffusion restriction and adjacent meningeal enhancement.

There are associated two T2 hyperintense  ring enhancing lesions   in left temporal lobe and in left cerebellar hemisphere showing central diffusion restriction and dual rim sign seen on SWI images .



  • Otitis media and mastoiditis is a common otologic conditions in pediatric and adult populations.
  • Diagnostic criteria for Acute mastoiditis:  ≥ 2 of the following intramastoid findings:
    • Fluid accumulation.?
    • Enhancement?
    • Diffusion restriction.
  • Additional intracranial complications which should be looked at in imaging include –
    Subdural and epidural empyemas, intraparenchymal brain abscesses, Sigmoid or transverse sinus thrombosis, brain infarcts, petrous capacities, and otitic hydrocephalus.
  • Otogenic brain abscess is seen most often in the temporal lobe or in the anterior portion of the lateral lobe of the cerebellum.
  • Central diffusion restriction, Smooth ring enhancement, and dual rim sign are useful imaging clues in identifying brain abscesses.

Dr. Sriram Patwari
MD, PDCC (Neuroradiology)
Consultant Radiology, Co-lead Neuroradiology
Manipal Hospitals Radiology Group

Dr. Vivek Jirankali
Senior resident and Cross-sectional fellow
Manipal Hospitals Radiology Group