Delayed brain abscess formation after mechanical thrombectomy for probable septic cerebral embolism: A case report...

Septic cerebral embolisms (SCE) are serious neurological complications of sepsis. An embolic occlusion due to infected thrombi can precipitate ischemic stroke and a spectrum of secondary pathologies, including intracerebral hemorrhages, mycotic aneurysms, meningitis, and brain abscesses, which are a major complication of SCE. However, delayed abscess formation following cerebral infarction is rarely encountered, and the underlying mechanisms remain poorly understood. Here, we present a rare case of SCE in a patient who underwent a mechanical thrombectomy (MT) for large-vessel occlusion and developed delayed abscess formation following cerebral infarction.

A 46-year-old man with a history of aortic stent graft implantation presented with sudden impairment of consciousness and right hemiparesis. Neuroradiological imaging revealed a left middle cerebral artery territory infarction due to occlusion of the left internal carotid artery. We performed emergency MT and achieved partial reperfusion. Histopathological evaluation of the retrieved thrombi revealed the presence of bacterial aggregates, confirming the diagnosis of SCE. Despite initial empiric antibiotic therapy, the patient developed a delayed brain abscess in the infarcted territory during the subacute phase. This unexpected course required further therapeutic intervention, including neurosurgical procedures and subsequent antibiotic therapy.

This case highlights both the diagnostic value of retrieved thrombi in SCE and the potential for delayed abscess formation after recanalization therapy using MT. In addition, this finding suggests the importance of ongoing vigilance for delayed brain abscess formation following SCE. In a severe clinical condition of sepsis, early diagnosis and tailored interventions are essential to improve outcomes.