A Recurred Brain Abscess in Same Area after Complete Enucleation

ABSTRACT

A brain abscess recurred after complete removal of encapsulated mass on the quite same spot three months later. 23-year-old woman was admitted to our hospital because of headache and vomiting for 3 months. On admission, she was mentally alert but the bilateral optic discs were markedly blurred. Left carotid angiogram and Conray ventriculogram suggested a large space-occupying lesion. At the time of operation, a large mass was removed with slightest occipital damage to the brain. On selection of the extirpated mass, thick purulent liquid came out. After operation, her neurological deficits were markedly improved except the equivocal hemiparesthesia of the right extremity. Postoperative course was quite uneventful and she was discharged. After 3 months postoperatively, she was re-admitted with recurrence of the trouble. She was comatose at this time. Pupillary light reflex was abolished. Pathologic reflexes were positive. The angiography and brain scan revealed recurrence of abscess on the just same area. Puncture for aspiration was immediately performed. Purulent materials were drained about 40ml. After abscess cavity was irrigated with physiologic saline solution, instillation of penicillin and micropaque was done within cavity. After several repeated puncture and aspiration her conditions were dramatically improved. Again, she became almost asymptomatic and was discharged days later her second admission. The results are as following ; 1. Primary focus of bacterial spreading to the brain was not found on both occasions. 2. Pathogenesis of both occasions was not clear. 3. At time of first operation, evidence of local inflammation was not found. 4. Local process and other induration was not found. These were confirmed with the operation and brain scanning. 5. Recurred brain abscess was newly developed. It seems to be hematogenous spreading in anywhere else.