Acute cerebrovascular incident caused by septic emboli: a case report

Septic embolism is a rare disorder associated with infective endocarditis, urinary tract infections, bone infections, femoral thrombophlebitis and sinusitis. We present a 53-year-old patient with multiple systemic embolism and cerebral infarction resulting from aortal thrombus after surgical treatment of the right fibular malleolar fracture with osteosynthetic material placement. After the surgery, the patient became antisocial, with decreased appetite and substantial weight loss. Computerized tomography scan showed several small hypodense zones in the supratentorial and periventricular region of the brain as well as bilateral pleural effusion, large infarcts of the spleen and right kidney, smaller infarcts of the lower pole of the right kidney, discontinuity of the wall of the thoraco-abdominal aorta and a thrombus present in the distal part of abdominal aorta. The findings primarily indicated septic emboli. The right ankle x-ray showed still present postoperative fracture gap of the right fibular malleolus with reduced bone mineralization but no signs of bone destruction. Control MSCT of the abdomen showed a large spleen abscess of 10x6 cm in size. Due to edema of the right ankle, ultrasonography was performed to reveal a thick content in the joint. The patient was transferred to University Department of Surgery, where splenectomy with evacuation of the perisplenic abscess together with extraction of the osteosynthetic material of the right fibular malleolus was performed. If not promptly diagnosed, septic emboli can cause devastating neurologic damage. In our patient, early diagnosis and intensive physical therapy facilitated almost complete regression of his neurologic deficit.