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Updated: Jan 8, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Unexpected infectious complication following AVM embolization: E. coli brain abscess
Andrii Netliukh1,2,3, Andrian Sukhanov1,3, Nana Tchantchaleishvili2,4
11st Lviv Territorial Medical Union, Lviv, Ukraine.
Background:
Brain arteriovenous malformations (AVMs) are rare vascular anomalies managed with surgery, radiosurgery, or endovascular embolization. Post-embolization intracranial infections are extremely uncommon, especially Escherichia coli abscesses in immunocompetent adults.
Case Presentation:
We report a 37-year-old man with a giant left frontal AVM treated with staged Onyx® embolization. One month after the final session, he developed a left frontal brain abscess with motor aphasia and right-sided hemiparesis. Cultures grew hemolytic E. coli sensitive to multiple antibiotics. Recurrence after initial drainage necessitated complete AVM and nidus resection, followed by prolonged targeted antibiotic therapy, leading to resolution and neurological recovery.
Literature Review:
Intracranial E. coli infections and post-AVM embolization abscesses are rare, typically associated with systemic or local immunosuppression. Our case is among the first describing hemolytic E. coli abscess after Onyx® embolization in a healthy adult.
Conclusion:
Retained embolic material, local inflammation, and blood-brain barrier disruption may facilitate infection. Early recognition and total removal, and prolonged targeted antibiotics are crucial to prevent recurrence and ensure favorable outcomes.
Insights
A rare brain abscess caused by Escherichia coli occurred in an immunocompetent adult after brain arteriovenous malformation embolization. Prompt surgical removal and antibiotics led to recovery, highlighting the importance of early detection and treatment.
Area of Science:
- Neurology
- Neurosurgery
- Infectious Diseases
Background:
- Brain arteriovenous malformations (AVMs) are rare vascular anomalies.
- Treatment options include surgery, radiosurgery, and endovascular embolization.
- Intracranial infections post-embolization are very uncommon, particularly in immunocompetent individuals.
Purpose of the Study:
- To report a rare case of an immunocompetent adult developing an intracranial abscess after AVM embolization.
- To discuss the challenges and management of such rare post-procedural infections.
Main Methods:
- A case presentation of a 37-year-old man with a giant left frontal AVM treated with Onyx® embolization.
- Detailed description of the diagnostic process, including microbiological cultures.
- Surgical intervention involving drainage, AVM resection, and prolonged antibiotic therapy.
Main Results:
- The patient developed a left frontal brain abscess caused by hemolytic Escherichia coli one month after embolization.
- The infection recurred after initial drainage, necessitating complete AVM and nidus resection.
- Prolonged targeted antibiotic therapy resulted in resolution of the abscess and neurological recovery.
Conclusions:
- Intracranial Escherichia coli abscesses post-AVM embolization are rare, especially in healthy adults.
- Potential contributing factors include retained embolic material, inflammation, and blood-brain barrier disruption.
- Early recognition, complete surgical removal, and extended antibiotic treatment are critical for favorable outcomes.
