Brain abscess after stent-assisted coiling for ruptured middle cerebral artery aneurysm

Abstract

A 24-year-old man was admitted with sudden severe headache. Brain computed tomography (CT) revealed a subarachnoid hemorrhage in the basal cistern and both Sylvian cisterns and a left internal carotid artery angiogram showed a small aneurysm on the bifurcation of the left middle cerebral artery. We performed Y-configured stent-assisted coil embolization. On the fifth post-embolization day, the patient had chills, and his body temperature was over 38℃. Staphylococcus aureus was cultured from the venous blood sample. Central venous catheter-induced bacteremia was suspected. The central venous catheter was immediately removed, and an antibiotic to which the organism was susceptible (nafcillin) was injected for 15 days according to the result of the antibiotics sensitivity test. He was discharged without any clinical or neurological symptoms on the 32nd hospital day. Three months after treatment, the patient complained in the outpatient department of headache, nausea and vomiting. Brain magnetic resonance imaging showed several well-rimmed enhancing lesions in the left temporoparietal lobe. The headache, nausea and vomiting was aggravated, and brain CT showed more enlarging cysts and aggravation of the midline shift. Stereotactic aspiration was performed for the three biggest cysts, and greenish-white colored pus was aspirated. The identified pathogen was methicillin-sensitive Staphylococcus aureus in the culture study. Vancomycin and ceftriaxone were administered intravenously for three weeks, followed by intravenous injection of nafcillin for five weeks. The patient’s postoperative course was clinically uneventful, and brain CT on postoperative day 57 showed total disappearance of the rim-enhanced abscess.