Legend A large, heterogeneous mass is located in the right frontal lobe with surrounding edema and mild subfalcine midline shift.

Legend On post contrast images, a thick enhancing rim is seen. There is also some restricted areas of diffusion present within the mass.

Legend MRS demonstrates markedly elevated lactate and lipids within the mass. No abnormally elevated choline is seen. Of note, elevated ketone levels are seen in the reference region of the brain parenchyma as well as in the mass. Key words: mri infection metabolic mrs

Brain Diagnosis: Streptococcal abscess Diabetic ketoacidosis