Computerized tomography is not reliable in the diagnosis of brainstem infection

The case of a 17-year-old girl who presented with a two-day history of absolute dysphagia secondary to a bulbar palsy due to a pre-pontine abscess is described. Rigid oesophagoscopy was normal and a neurology consultation suggested a central cause for her dysphagia. However the diagnosis was delayed because a computed tomography (CT) scan of her brain and brainstem was reported as normal. A subsequent magnetic resonance image (MRI) scan revealed a pre-pontine abscess. CT scanning is not as reliable as MRI in the diagnosis of infective lesions of the brainstem/brain, especially early in the course of the infection.