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The diagnosis of intracranial focal lesions based on imaging studies is a challenge. In brain abscess, proton magnetic resonance spectroscopy (1H-MRS) is useful to define etiology, differentiating anaerobic from aerobic pathogens and inclusive sterile abscess based on the behavior of certain metabolites. We report a patient with Rendu-Osler-Weber syndrome, pulmonary arteriovenous fistulas, and brain abscesses characterized by brain magnetic resonance imaging (MRI), with a spectroscopy pattern compatible with anaerobic infection.

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