Cerebral abscess with pneumocephalus.

摘要

A 57-year-old man presented with a 2-week history of confusion and low-grade fever. His history included alcoholism, hypertension, type 2 diabetes mellitus and a left internal capsular infarct. Ten years earlier he had presented with multiple cerebral abscesses and cerebro-spinal fluid (CSF) rhinorrhoea. A biopsy of the abscess at that time had cultured Streptococcus pneumoniae which responded to i.v. antibiotics, but he had refused surgery.On this admission, a computed tomography scan showed fluid in the sinuses, pneumocephalus, and an air-fluid level suggestive of an abscess (Fig. 1). Lumbar CSF showed increased protein, a neutrophilia of 13 x 109/L, glucose 1.2 mmol/L and no growth on culture. CSF antigens for Haemophilus influenzae, S. pneumoniae, Group B streptococci and Neisseria meningitides were negative, as were blood cultures. A transoesophageal echocardiogram showed no abnormality.