Septic Embolic Stroke Followed by Hemorrhage and Brain Abscess in a Patient with Systemic Infections: A Case Report and Literature Review

Abstract

We report a case of 50-year-old man with a severe acute ischemic stroke followed by intracerebral hemorrhage and brain abscess due to systemic infection. His initial intracranial radiographic findings were normal but three days later MRI scan of the brain revealed well-defined rounded cystic lesion on the T2-weighted and T1-weighted images in the right basal ganglia; the lesion presented an area of diffusion restriction on DWI; lately the lesion was confirmed to be an early stage of cerebral abscess. A week later the patient was noted to have worsening neurological status and left extremity weakness, and emergency brain CT scan revealed massive intracerebral hemorrhage in the right occipital lobe; he underwent intracranial hematoma evacuation surgery. The hematoma was removed successfully, and the systemic infections were treated with antibiotics.

Cerebral Microhemorrhages Secondary to a Hypervirulent <i>Klebsiella Pneumoniae</i> Infection

“…Although multiple cerebral hemorrhages are rarely seen in bacteremia cases, except for cases of infective endocarditis (IE), we assume that this patient most likely did not have IE, since transthoracic echocardiography showed no evidence of either hvKP vegetation nor valvular disease or congenital heart disease, which can be risk factors for IE. The findings of the present case are indicative of the severe invasiveness of hvKP leading to the onset of microvasculopathies such as vasculitis and mycotic aneurysm formation, which can cause cerebral hemorrhages even in the absence of IE (1,2).…”