Cerebral abscesses secondary to contusions

Case contributed by A.Prof Frank Gaillard

Presentation

On warfarin for AF fell.

Patient Data

Age: Elderly
Gender: Male
CT

CT brain

Non contrast CT of the brain demonstrates large haemorrhagic contusions. 

CT

CTB 3 weeks later

CT scan with contrast 3 weeks later, when the patient was febrile and deteriorating clinically demonstrates the contusions to be peripherally enhancing. 

.

This patient went on to have a craniotomy and evacuation of the collections. 

Histology

Microscopic Description:  

Sections of  RIGHT BRAIN HEMATOMA show degenerating red blood cells and focal collections of degenerating polymorphonuclear leukocytes. 

Sections of  RIGHT BRAIN CAPSULE show necrotic brain parenchyma with adjacent deposition of fibrin. There are extensive inflammatory infiltrates, which are poorly preserved. There is new blood vessel formation. Special stains were done; no organisms were seen on Gram, Grocott, Ziehl Neelsen and modified Ziehl Neelsen stains. 

However, some structures consistent with bacilli were evident on the Giemsa stain.

Final Diagnosis:  The findings are consistent with early abscess formation and haemorrhage.

Case Discussion

This elderly patient on warfarin for AF fell and developed bilateral frontal haemorrhagic contusions. During his convalescence he became uroseptic and subsequently meningitic. 

MRI and histology confirmed secondary infection, with development of cerebral absceses. He had a protracted and stormy clinical course but eventually recovered. 

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Case information

rID: 5201
Case created: 16th Dec 2008
Last edited: 22nd Mar 2016
Inclusion in quiz mode: Included

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