Abstract
The aim of this article was to present a rare and potentially life-threatening complication
of malignant cerebral infarct turning into a massive cerebral abscess. Cerebral abscess
complicating cerebral infarction is rare. Only 13 cases have been reported. Unexplained
fever is the presenting symptom. The case presented here is unique, as the patient
was totally asymptomatic and the abscess was detected incidentally during surgery.
A 42-year-old man with malignant left anterior cerebral artery and middle cerebral
artery territory infarct underwent decompressive craniotomy 5 weeks before presenting
to the authors’ institution. The patient had features of sunken skin flap syndrome.
Therefore, cranioplasty was planned. During surgery, false dura was inadvertently
opened due to adherence with pia and pus started coming out. On exploration, approximately
150 mL of pus was evacuated. The whole infarcted brain was seen to be converted into
a cavity full of pus. Adequate drainage and debridement were done. Cranioplasty was
deferred. The patient was treated with broad-spectrum antibiotics postoperatively,
and he recovered well. Cerebrovascular accident (CVA) is one among the common causes
for mortality and morbidity worldwide. The infarcted or ischemic brain acts like a
fertile ground for the pathogens to grow. Disruption of blood–brain barrier and lack
of normal blood flow by the vascular event facilitate microbial seeding and formation
of cerebral abscess. Abscess formation following stroke is rare. It could prove to
be fatal if misdiagnosed or not properly treated. Uncontrolled fever in a stroke patient
should raise the suspicion of this rare complication. A routine contrast computed
tomography of the brain prior to cranioplasty may pick up this complication in asymptomatic
patients. Conservative treatment alone proves fatal in almost all cases.
Keywords
cerebral abscess - cerebral infarct - meningitis
