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[Brain abscess following intracerebral hematoma]
H Kurihara1, T Mitsui, N Kohno
1Department of Neurosurgery, Kiryu Kohsei General Hospital, Japan.
No Shinkei Geka. Neurological Surgery
|November 1, 1989
Summary
A brain abscess developed in a patient with a prior putaminal hemorrhage, likely due to bacterial seeding from a leg vein infection. This case highlights the risk of delayed brain abscess formation after cerebral vascular events.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Cerebral vascular disease, specifically putaminal hemorrhage, can lead to neurological deficits.
- Superficial phlebitis is a potential source of systemic infection.
Observation:
- A patient with left hemiparesis due to right putaminal hemorrhage developed superficial phlebitis in the left leg.
- Despite antibiotic treatment for phlebitis, local inflammation and leukocytosis persisted.
- Four months later, the patient experienced exacerbated hemiparesis, with CT revealing a ring-enhancing lesion at the hematoma site.
Findings:
- Stereotactic aspiration yielded Staphylococcus, confirming a brain abscess with hemosiderin deposits.
- Histopathology revealed a brain abscess, suggesting the hematoma served as a locus minoris resistentiae.
- The abscess size progressively diminished on follow-up CT scans.
Implications:
- Brain abscess formation should be considered in patients with neurological deterioration following a cerebral vascular event.
- Bacterial seeding of a cerebral hematoma from a distant infection source, like phlebitis, can lead to abscess development.
- This case underscores the importance of vigilance for secondary complications in patients with cerebrovascular disease and concurrent infections.