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Case Reports
. 2012 Nov 5;12:133.
doi: 10.1186/1471-2377-12-133.

An Emboligenic Pulmonary Abscess Leading to Ischemic Stroke and Secondary Brain Abscess

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Free PMC article
Case Reports

An Emboligenic Pulmonary Abscess Leading to Ischemic Stroke and Secondary Brain Abscess

Philipp Albrecht et al. BMC Neurol. .
Free PMC article

Abstract

Background: Ischemic stroke by septic embolism occurs primarily in the context of infective endocarditis or in patients with a right-to-left shunt and formation of a secondary cerebral abscess is a rare event. Erosion of pulmonary veins by a pulmonary abscess can lead to transcardiac septic embolism but to our knowledge no case of septic embolic ischemic stroke from a pulmonary abscess with secondary transformation into a brain abscess has been reported to date.

Case presentation: We report the case of a patient with a pulmonary abscess causing a septic embolic cerebral infarction which then transformed into a cerebral abscess. After antibiotic therapy and drainage of the abscess the patient could be rehabilitated and presented an impressive improvement of symptoms.

Conclusion: Septic embolism should be considered as cause of ischemic stroke in patients with pulmonary abscess and can be followed by formation of a secondary cerebral abscess. Early antibiotic treatment and repeated cranial CT-scans for detection of a secondary abscess should be performed.

Figures

Figure 1
Figure 1
a) T2 weighted axial image displayed a hyperintense cortical signal alteration in two adjacent gyri of the left supplementary motor cortex (white arrow).b) This lesion was hyperintense in the axial diffusion weighted image (b = 1000 sec/mm2. Although it showed only minimally lowered ADC values (Apparent Diffusion Coefficient, black arrow, c), these findings were primarily consistent with an acute infarction. d) The index finger of his left hand showed a typical Janeway lesion highly indicative of a septic-embolic focus. Chest X-Ray (e) and computed tomography (f) showed a large fluid and air containing process in the right lower lobe consistent with a septic lung abscess. g) A computed tomography two days later revealed a now well demarcated lesion (native scan in axial orientation, black arrow). h) A further nine days later, after clinical deterioration a repeated scan revealed a large left frontal mass (native scan) with ring-like enhancement after i.v. administration of iodine contrast media (i). The findings were now typical for a brain abscess.

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