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A Patient with a Brain Abscess Presenting as an Acute Stroke
Thomas Matthews1, Cathy Keegan1, David McDonnell1
1Department of Medicine, Tipperary University Hospital, Clonmel, County Tipperary, Ireland.
European Journal of Case Reports in Internal Medicine
|April 13, 2023
Summary
A large brain abscess was successfully treated in a 71-year-old man presenting with confusion and neurological deficits. This case highlights the importance of considering brain abscess even without sepsis signs.
Area of Science:
- Neurology
- Infectious Diseases
Background:
- Brain abscesses are focal brain infections.
- They can arise from various sources like infections or trauma.
- Atypical presentations can mimic other neurological conditions.
Purpose of the Study:
- To report a case of a large brain abscess.
- To emphasize diagnostic considerations in atypical presentations.
- To illustrate successful treatment outcomes.
Main Methods:
- Case report of a 71-year-old male.
- Neuroimaging revealed a 5 cm temporal lobe abscess.
- Treatment involved craniotomy, evacuation, and prolonged antimicrobials.
Main Results:
- The patient recovered fully to his pre-morbid state.
- A complication of fungemia (candidaemia) occurred due to antifungal treatment.
- This complication was successfully managed with antifungal therapy.
Conclusions:
- Maintain a high suspicion for brain abscess with ring-enhancing lesions on imaging, even without sepsis indicators.
- Commensal yeasts can colonize indwelling lines during long-term antibiotic therapy.
- Concomitant diagnoses can delay the recognition of primary brain abscess.
