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Open Access Case report

An emboligenic pulmonary abscess leading to ischemic stroke and secondary brain abscess

Philipp Albrecht1*, Mark Stettner1, Leila Husseini1, Stephan Macht2, Sebastian Jander1, Colin Mackenzie3, Ulrike Oesterlee4, Philipp Slotty5, Axel Methner1, Hans-Peter Hartung1 and Orhan Aktas1

Author Affiliations

1 Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany

2 Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany

3 Department of Medical Microbiology and Hospital Hygiene, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany

4 Department of Cardiology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany

5 Department of Neurosurgery, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany

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BMC Neurology 2012, 12:133  doi:10.1186/1471-2377-12-133

Published: 5 November 2012

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.