THE HEMORRHAGIC COMPLICATION OF A CEREBRAL ABSCESS, DIAGNOSTIC DIFFICULTIES AND TREATMEN. CASE REPORT
Abstract:
Cerebral abscess is an infection of the central nervous system (CNS) that occurs through the dissemination of the pathogen agent from an infection situated nearby or from a distant source (travelling by blood pathway). Patients usually have nonspecific neurological manifestations, with unpredictable and sometimes fatal consequences. The occurrence of the hemorrhage in the cerebral abscess is a rare complication that raises issues regarding the differential diagnosis and treatment, especially in patients whose anticoagulant therapy for associated pathology cannot be interrupted. The current case is that of a man who has a metallic valvular prosthesis situated in mitral position and who has previously had sepsis. He is being administrated an overdose of oral anticoagulant treatment; he also has a motor neurological deficit and sudden partial epileptic seizures. Computer tomography (CT) examination of the brain revealed two hyperdense areas (right parietal and left frontal) which generated discussions regarding positive diagnosis: cerebral hemorrhage by overdosing the anticoagulant, cerebral secondary determinations or brain abscesses. Imagistic re-evaluations associated with the disease evolution, persistent inflammatory syndrome and fever have imposed a neurosurgical intervention. The pathological examination and the cultures taken from the cerebral abscess have confirmed Enterococcus as etiological agent of cerebral abscess. The optimal anticoagulation treatment in maintaining the cardiac valvular function has been a challenge, given the hemorrhagic complications of the abscess and the surgical intervention.
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