From Suspected Brain Tumor to Cerebral Abscess: A Case Report

Cerebral abscesses can mimic brain tumors or metastases on imaging, posing a significant diagnostic challenge, especially in patients without obvious infectious sources. We report the case of a 46-year-old woman with a history of spinal cord lesion biopsy, who presented with a three-week history of headaches and vomiting, progressing to dysarthria, right-sided hemiplegia, and consciousness impairment over 24 hours. On admission, she was unconscious (Glasgow Coma Scale (GCS) 7/15), with left anisocoria, requiring intubation and mechanical ventilation. Brain CT revealed intra-axial lesions suggestive of cerebral metastases. Emergency surgery was performed on the largest left frontoparietal lesion. Intraoperatively, the lesion contained purulent material, which was sterile on microbiological culture. No preoperative antibiotics had been administered. Histopathology confirmed the presence of purulent material, consistent with a cerebral abscess. Postoperatively, the patient received triple antibiotic therapy, corticosteroids, and intensive supportive care. Despite maximal treatment, there was no neurological improvement, and the patient subsequently died. This case highlights the difficulty in differentiating cerebral abscesses from metastatic brain tumors in the absence of a clear infectious source. Early consideration of abscess in the differential diagnosis and prompt surgical intervention remain critical, although outcomes may be poor in rapidly progressing cases.