Asymptomatic Brain Abscess with Intracerebral Hemorrhage

Excerpt

A 44-year-old man with hypertension and diabetes presented with an acute headache and left hemiparesis. He reported recent inadequate control of blood pressure and diabetes. At the time of admission, his blood pressure was 240/130 mmHg, but fever and myalgia were absent. Immediate computed tomography (CT) revealed a right frontotemporal lobe intracerebral hemorrhage (ICH), and some areas of ICH appeared to be associated with other lesions (Fig. 1). Immediate surgery was performed because of rapidly deteriorating consciousness. After insertion of a catheter to the nearest ICH site, white purulent discharge was observed and irrigation was performed. Blood tests revealed unremarkable findings, with the exception of a slightly increased C-reactive protein level (0.12 mg/L). Staphylococcus saprophyticus was detected on culture, and vancomycin was given for 21 days. Postoperative CT confirmed that the fluid level disappeared and problems caused by the mass as a space-occupying lesion had nearly resolved (Fig. 2). The patient became more alert, and the left hemiparesis gradually improved.

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