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Brain abscess — SCE Neurology MCQ

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HardCNS InfectionsBrain abscessSCE Neurology

MRI in an immunocompetent 61-year-old shows a homogeneously enhancing, diffusion-restricting periventricular mass suspicious for primary CNS lymphoma. He is stable without impending herniation. What is the most appropriate next diagnostic strategy?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Avoid corticosteroids and arrange urgent stereotactic biopsy through the PCNSL pathway

Explanation lettering: E = shown as A · A = shown as B · B = shown as E

C is correct: suspected PCNSL needs rapid specialist discussion and tissue diagnosis, while corticosteroids should be avoided before biopsy when clinically possible because lymphocytotoxic regression can make the specimen non-diagnostic. A creates exactly that risk; response to steroid is not diagnostic. B is not the routine diagnostic operation for a deep PCNSL lesion. D starts definitive treatment without histology. E is wrong because CSF cytology has limited sensitivity and a negative result cannot exclude a parenchymal lymphoma.

Reference: British Society for Haematology guideline for primary CNS lymphoma: https://onlinelibrary.wiley.com/doi/full/10.1111/bjh.15661