Brain abscess caused by escherichia coli following embolization of a giant arteriovenous malformation. Clinical case

Abstract

Embolization is one of the four approaches to the treatment of arteriovenous malformations. Typical complications of endovascular interventions include intraoperative or postoperative hemorrhage, ischemic stroke, perforation or dissection of a vessel, forced retention of a microcatheter in vessels due to polymerization of embolic material. Infectious complications after endovascular interventions and brain abscesses caused by Escherichia coli have been reported quite rarely. Although abscess formation after embolization is extremely rare, it is a serious condition that requires immediate treatment. This is a case of a unique clinical picture of a spontaneous brain abscess caused by Escherichia coli on the background of a giant arteriovenous malformation in an adult man without a typical route of infection and immunosuppression. This possibility should be taken into account in the treatment of arteriovenous malformation of the brain. A 37-year-old patient complained of convulsive attacks, increased body temperature, impaired speech, and right-sided hemiparesis. A brain abscess developed 1 month after the third stage of embolization of a giant arteriovenous brain malformation. Cultures of the contents of the abscess showed a positive result for Escherichia coli. During the long course of treatment, relapses of the abscess were registered several times, with each of them a complex approach to solving the problem was used ‒ a combination of surgical intervention and antibiotic therapy. Choosing the most effective method of treatment makes it possible to prevent or reduce the likelihood of complications and improve the patient's quality of life. Long and repeated procedures, partial exclusion of the malformation, repeated passages with microinstrumentation, use of a significant amount of substance for embolization can cause the development of inflammation, thrombus formation in the vessels of arteriovenous malformations and increase the risk of developing purulent-infectious complications after endovascular neurosurgical interventions. Consideration of the given clinical case will contribute to deepening the understanding of this pathology.