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Intraventricular rupture of Nocardia brain abscess--case report
Shinya Oshiro1, Hirokazu Ohnishi, Mika Ohta
1Department of Neurosurgery, Sasebo Central Hospital, Sasebo, Nagasaki, Japan. oshiro_shinya@hosp.pref.okinawa.jp
Abstract:
A 71-year-old male presented with left hemiparesis and confused conversation. Computed tomography showed a mass lesion with rim enhancement in the right parietal lobe. He developed meningeal irritation the day after admission. Emergent fluid-attenuated inversion recovery (FLAIR) magnetic resonance (MR) imaging revealed a clear hyperintense component in the right lateral ventricle and niveau formation inside the intracerebral lesion, indicating intraventricular rupture of the brain abscess. The patient underwent aspiration of the abscess and ventricular drainage with antibiotic administration. Nocardia asteroides was isolated from the aspirated pus, so systemic and direct administration of effective antibiotics was subsequently commenced. These procedures resulted in gradual improvement of his clinical course, and he left our hospital. Several days after discharge, he developed acute pan-peritonitis due to malignant lymphoma. He appeared to be progressively deteriorating after an exploratory laparotomy, and died on the 17th day after the laparotomy. Intraventricular rupture of nocardia brain abscess can be successfully treated after early definitive diagnosis with FLAIR MR imaging.
Insights
Early diagnosis of Nocardia brain abscess rupture using FLAIR MRI led to successful treatment. This case highlights effective management of intraventricular rupture in brain abscesses.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Brain abscesses are serious infections requiring prompt diagnosis and treatment.
- Intraventricular rupture of a brain abscess presents a critical neurosurgical emergency.
Observation:
- A 71-year-old male presented with neurological deficits and a right parietal lobe mass.
- Computed tomography revealed a rim-enhancing lesion, followed by meningeal irritation.
- Fluid-attenuated inversion recovery (FLAIR) magnetic resonance (MR) imaging demonstrated intraventricular rupture and niveau formation.
Findings:
- Cerebral abscess caused by Nocardia asteroides was diagnosed via pus aspiration.
- Successful treatment involved abscess aspiration, ventricular drainage, and targeted antibiotic therapy.
- The patient initially improved but later succumbed to complications from unrelated malignant lymphoma.
Implications:
- FLAIR MR imaging is crucial for the early and definitive diagnosis of intraventricular brain abscess rupture.
- Prompt surgical intervention and appropriate antibiotic administration are key to managing Nocardia brain abscesses.
- This case underscores the importance of advanced imaging in identifying complex neurosurgical conditions.