Clinical Characteristic of 12 Misdiagnosed Cases With Rare Intracranial Infection

Abstract

Object: To investigate the clinical features and radiologic findings in misdiagnosed intracranial infection. Methods: A series of 12 uncommon patients with misdiagnosed intracranial infection were enrolled in the present study from January 2004 to December 2013. Results: All patients with rare intracranial infections were confirmed by histopathologic examination; the misdiagnosis rate is 100% in the present series. The initial diagnosis included metastatic tumor, glioma, meningioma, cyst disease, hematoma, and epidermoid cysts. The features of magnetic resonance imaging were isointense (5/12), hyperintense (5/12), hypointense (2/12) on T1 weight, and hypointense (4/12) and hyperintense (8/12) on T2 weight, respectively, as well as nonspecific enhanced findings in the present study. The most common etiology of misdiagnosed intracranial infections was fungal abscess and neurocysticercosis that account for 25% (3/12) of the infections. Uncommon intracranial toxoplasmosis in 1 case and 1 case of cerebral alveolar echinococcosis in 1 case were also observed, respectively (8.3%). In addition, 2 cases (16.7%) of all patients were proved to have intracranial abscess with specific pathogen: one is Staphylococcus aureus, and the other is Serratia marcescens. Two intracranial abscesses (16.7%) with nonspecific pathogen were also found in the present study. The follow-up was conducted on all patients during a period of 3 to 96 months (average, 48 mo), of which 91.7% patients had a favorable outcome (Glasgow Outcome Scale 5 and 4) and 8.3% had an unfavorable outcome (Glasgow Outcome Scale ≤3). Conclusions Primary diagnosis of rare intracranial infections should be emphasized; favorable outcome could be achieved by early microsurgical intervention and timely effective antibiotics.