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[Nocardia brain abscess: a case report (author's transl)]

Y Oda, K Mori, A Kobayashi

    No Shinkei Geka. Neurological Surgery
    |January 1, 1982
    PubMed
    Summary

    A brain abscess caused by Nocardia species was successfully treated in a patient with a lung shadow. Prompt diagnosis and surgical intervention, followed by antibiotic therapy, led to a favorable outcome.

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    Area of Science:

    • Neurology
    • Infectious Diseases
    • Radiology

    Background:

    • A 42-year-old woman presented with neurological symptoms including headache, anorexia, dysarthria, and right facial weakness.
    • Initial chest radiography revealed an abnormal shadow in the left lower lung field.

    Observation:

    • Neurological examination showed bilateral papilledema, right hemiparesis, and total dysphasia.
    • CT scan revealed a heterogeneously enhanced mass in the left posterior frontal lobe with significant cerebral edema, initially suspected as a metastatic lung tumor.

    Findings:

    • Craniotomy identified an abscess cavity, and histological examination confirmed the presence of Nocardia species.
    • The patient developed a subsequent Corynebacterial epidural empyema, which was surgically evacuated.
    • Treatment involved a combination of trimethoprim-sulfamethoxazole (Baktar) and minocycline, followed by prolonged Baktar therapy.

    Implications:

    • This case highlights the importance of considering Nocardia brain abscess in patients with pulmonary abnormalities and neurological deficits.
    • Successful management involved a multidisciplinary approach including neurosurgery, infectious disease consultation, and prolonged antibiotic therapy.
    • Early diagnosis and intervention are crucial for favorable outcomes in Nocardia brain abscesses, even in the presence of complicating factors such as epidural empyema.

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