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Nocardia brain abscess misinterpreted as cerebral infarction.
1Neurosurgical Department, Klinikum, Aschaffenburg, Germany. wolfgang.boerm@medizin.uni-ulm.de
Summary
A brain abscess caused by Nocardia was initially misdiagnosed as a stroke in an immunocompromised patient. Prompt surgical intervention was necessary after initial treatment proved inadequate due to misinterpretation of imaging and lack of infection signs.
Area of Science:
- Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Cerebral infarction and brain abscesses can present with similar neurological deficits such as hemiparesis and aphasia.
- Nocardia brain abscesses are rare, particularly in non-immunocompromised individuals, posing diagnostic challenges.
Observation:
- A non-immunocompromised man presented with right-sided hemiparesis and aphasia, initially suspected to be cerebral infarction.
- Clinical presentation lacked overt signs of infection, complicating the differential diagnosis.
Findings:
- Subsequent clinical course revealed the condition to be a Nocardia brain abscess, necessitating surgical intervention.
- Misinterpretation of neuroimaging and absence of infection indicators led to inappropriate initial management.
Implications:
- Highlights the importance of considering uncommon etiologies like Nocardia brain abscess in neurological presentations, even without typical infectious signs.
- Emphasizes the critical role of accurate imaging interpretation and comprehensive clinical assessment in guiding timely and appropriate treatment for brain lesions.