Abstract
Brain abscess, a severe intracranial infectious disease, refers to the parenchyma abscess caused by local infection or remote spread. Recently, advancements in modern medicine, especially the wide application of antimicrobial drugs, have contributed to the gradual decrease in the prevalence of this disease. However, cases of cryptogenic brain abscess that feature an unknown origin and atypical symptoms are rising. In this retrospective study, we report and analyze two cases of cryptogenic brain abscess. The first patient was a 30-year-old healthy man who was admitted to our hospital due to 1 week of headache and 3 days of headache aggravation, accompanied by nausea and vomiting. Head MRI shows a circular space-occupying as well as apparently enhanced DWI signals were observed in the right parietal lobe, and the ring wall manifested an apparent increase in signal intensity after enhancement. The patient was diagnosed as a brain abscess before operation and given craniotomy. The postoperative pathology confirmed brain abscess and recovered well after surgery. The second patient was a 45-year-old healthy woman who was hospitalized in a local hospital due to symptoms of headache and right limb weakness for 1 week. Head MRI shows a circular space-occupying lesion in the left basal ganglia, and the ring wall manifested an apparent increase in signal intensity after enhancement. The patient was suspected of glioma at the local hospital and was transferred to our hospital. Twelve hours after hospitalization, the patient was suspected of developing cerebral palsy and thus underwent emergency surgery including lesion resection in the left basal ganglia, resection of the polus temporalis, and a decompressive craniotomy. Postoperative pathology confirmed brain abscess. The patient was eventually conscious, but left the right limb hemiplegia. Hence, when a patient develops the classical triad of fever, headache, and focal neurologic deficits, the possibility of brain abscess should be investigated. Early diagnosis and treatment are crucial to minimize various complications and the number of deaths.
Highlights
Brain abscess is a severe intracranial infectious disease that has a prevalence of 0.4–0.9 per 100,000 population (Nicolosi et al, 1991; Helweglarsen et al, 2012) as well as high disability and morality rates
The current study reports two cases of cryptogenic brain abscess
Head magnetic resonance imaging (MRI), including a plain scan and an enhancement scan, showed the following: (i) irregularly circular, slightly long, aberrant T1 and T2 signal shadows with sheet-like, long T1 and T2 signals as well as apparently enhanced diffusion-weighted imaging (DWI) signals were observed in the right parietal lobe; (ii) an edge ring wall with a relatively even thickness presented as slightly short T1 and T2 signals; (iii) the ring wall manifested an apparent increase in signal intensity after enhancement; (iv) the lesion was surrounded by large patches of T1 and T2 oedema shadow; (v) the adjacent ventricles and parenchyma displayed compression-resulted deformation; (vi) the midline structures were slightly shifted toward the left (Figures 1A–G)
Summary
Brain abscess is a severe intracranial infectious disease that has a prevalence of 0.4–0.9 per 100,000 population (Nicolosi et al, 1991; Helweglarsen et al, 2012) as well as high disability and morality rates. The current study reports two cases of cryptogenic brain abscess Both patients had a recent history of good physical health, with no record of otitis media, sinusitis, heart diseases, head injury, or recent infection. A head computed tomography (CT) scan showed that the space-occupying lesion in the right parietal lobe had disappeared, the surrounding area had large patches of lowdensity shadows with a blurred boundary, and the midline structures displayed local left-shift (Figure 1H). Head CT revealed that the left space-occupying lesion disappeared; large patches or stripes of low-density shadows with blurred boundary were present in the surrounding areas; the surrounding brain tissue displayed swelling; and the midline structures remained in the middle (Figure 2F). Physical examination upon discharge revealed a normal body temperature, high level of consciousness, babbling, level 1 right limb muscle strength, and normal left limb muscle strength
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