Cerebellar Abscess Caused by Extension of an Otogenic Infection Through the Labyrinth and Internal Auditory Canal 1).
Yasutake et al. report a case of cerebellum abscess due to Fusobacterium nucleatum in a 60-year-old man. He was admitted to the hospital complaining of headache and dizziness. On admission, he was lucid with the following vital data:blood pressure, 136/89 mmHg;heart rate, 65 beats/min;body temperature, 37.0℃;and oxygen saturation, 100%. He had a moderate headache and could not walk straight. In general, there were no abnormal findings except for his poor dental hygiene. Laboratory findings revealed elevated white blood cell counts(10,900/mm3)and brain MRI revealed a mass shadow that was suspected to be an abscess in the left side of his cerebellum. Elective surgery was scheduled. However, consciousness of disorder was observed on the second hospital day and the size of mass shadow extended;hence, emergent drainage under craniotomy was performed. The diagnosis was cerebellum abscess, and F. nucleatum, which is a normal flora in the oral cavity, was isolated in his cerebellum abscess. After the surgery, his hospital course was positive under the treatment of antibiotics for F. nucleatum. The route of bacterial infection entry was unclear;however, it will be considered that abscesses in the central nervous system occur because of poor dental hygiene 2).
A 45-year-old woman with mastectomy. She had chemotherapy after surgery and had blood stem cell transplantation because of pancytopenia. Two months after treatments, MRI was performed on the development of ataxia and a cerebellar abscess was detected. The abscess was surgically excised and local amphotericin B was applied. She is stil alive and neurologically stable after 14 years of surgical treatment. In intracranial aspergillosis, intracavitary amphotericin B therapy may be used as an adjunct after the surgical excision of abscess. This procedure may contributes to the regression of abscess or prevention of the recurrence. But comparative clinical studies are needed for more accurate conclusions 3).
Streptococcus constellatus, a coccus from the normal genital, oral and gastrointestinal flora, has a tendency to form abscesses, but not to cause infective endocarditis (IE). Also, S. constellatus is an extremely rare causative agent of brain abscess. We report the case of a woman with a colorectal tumour who presented with IE and cerebellar abscesses due to a S. constellatus bacteraemia 4).
A 71-year-old man was diagnosed with hemorrhagic cerebellar abscess as a complication of groin abscess after cardiac catheterization. After surgical resection of the cerebellar abscess and culture-based antibiotic treatment, the patient suffered repeat hemorrhages into the abscess cavity, of which he died. We describe his clinical course with emphasis on radiology-based differential diagnosis. We also describe the possible pathogenesis of this rare case, based on review of the literature.
To our knowledge, this is the first report on recurrent hemorrhages in a cerebellar abscess. Hemorrhagic brain abscess has a complex radiologic appearance, which may delay diagnosis and treatment. A high degree of clinical suspicion is necessary to ensure timely treatment of this potentially lethal lesion 5).
A previously healthy adult who had a solitary cerebellar brain abscess diagnosed. This infection occurred 4 weeks after the patient underwent a tongue piercing procedure that was complicated by an apparent local infection. The clinical history, abscess culture results, and lack of an alternative explanation suggest that infection of the tongue piercing site was the source of the cerebellar abscess 6).