Brain Abscess Complicating an Intracranial Hemorrhage

Problem statement: A brain abscess presenting after an Intracranial Hemorrhage (ICH) is an extremely rare occurrence. Diagnosis in this setting is difficult, given the absence of key clinical features, such as neurologic deficit and headaches. Since a delay in the diagnosis of a brain abscess leads to poor outcomes, there should be a high index of suspicion for abscess in patients developing fever after an ICH. Approach: This is a case report describing the presentation, hospital course and management of a patient who was diagnosed with a brain abscess following an ICH. Results: A review of literature revealed only 15 such cases. The basal ganglia are the most common sites of infection. The mean interval between the ICH and the systemic infection which resulted in an abscess was 9.8 days. Time from infection to brain abscess formation was 8-140 days, with a mean of 20 days. There was a delay in diagnosis in earlier case reports. Conclusion: Although brain abscess is a rare complication after ICH, because of the high mortality and morbidity, it should be considered in patients who develop fever after ICH.