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Cryptogenic Perirolandic Brain Abscess in an Otherwise Healthy Young Man.
Mazen Taman1, Carl Porto1, Jean-Luc Lewis1
1Department of Neurosurgery Warren Alpert Medical School of Brown University Providence Rhode Island USA.
Clinical Case Reports
|April 27, 2026
Summary
A young male with recent sinus issues developed a brain abscess caused by Streptococcus intermedius. Prompt diagnosis, surgical drainage, and targeted antibiotics led to a full neurological recovery.
Area of Science:
- Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Intracranial infections can present atypically in young, otherwise healthy individuals.
- Sinonasal symptoms and minor head trauma can precede serious neurological events.
- Early recognition of focal neurological deficits is crucial for timely intervention.
Purpose of the Study:
- To report a case of brain abscess in a young male with cryptogenic origin.
- To highlight the diagnostic and management principles for intracranial infections.
- To emphasize the importance of microbiological diagnosis and source control.
Main Methods:
- Clinical presentation of a 19-year-old male with transient neurological deficits.
- Diagnostic imaging including CT and MRI to identify a left frontal brain lesion.
- Stereotactic aspiration for microbiological diagnosis and empiric/targeted antimicrobial therapy.
Main Results:
- Brain abscess cultures identified Streptococcus intermedius and Aggregatibacter aphrophilus.
- The patient received targeted intravenous antibiotics resulting in near-complete radiographic resolution.
- Full neurological recovery was achieved at 4-month follow-up with supportive care and physical therapy.
Conclusions:
- Maintain suspicion for intracranial infection in afebrile patients with focal deficits and recent sinonasal symptoms.
- Prioritize microbiological diagnosis and source control without delaying empiric therapy.
- Stereotactic trajectories should respect eloquent cortex to minimize postoperative deficits.
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