Delayed cerebellar abscess developed 38 years after craniocerebral gunshot wound: A case report

Brain abscesses are recognized complications of penetrating craniocerebral trauma, typically developing within 6-8 weeks following the initial injury. Delayed onset abscesses have been occasionally reported, with extremely few cases occurring decades after the trauma. The pathophysiological mechanisms behind such scenarios remain poorly understood, highlighting the need for heightened clinical suspicion in patients with a history of head injury who present with new neurological symptoms, regardless of the time elapsed.

We present the case of a 68-year-old male with gait instability, dizziness, and dysmetria. Past medical history was notable for a craniocerebral gunshot wound sustained 38 years earlier. Imaging revealed a cerebellar mass consistent with a brain abscess and neurosurgical intervention confirmed the diagnosis. The unusual latency between the initial injury and the development of the abscess raises significant questions about the long-term behavior of dormant infectious foci and the potential triggers for reactivation.

This case emphasizes the importance of considering remote trauma as the cause of new symptoms, even decades after the event. The possibility of a latent infection becoming active after a prolonged period remains a speculative yet critical issue. For survivors of penetrating brain injuries, clinicians must maintain a high index of suspicion when atypical symptoms arise. Delayed diagnosis due to unfamiliarity with such rare presentations can lead to suboptimal outcomes. This case also underscores the diagnostic challenge these scenarios pose, particularly for clinicians without specialized training. Awareness of this possibility may lead to earlier recognition and management, potentially improving patient outcomes.