Intracranial Calcification Caused by a Brain Abscess : A Rare Cause of Intracranial Calcification
A previously healthy 40-year-old man presented with mental deterioration after a head injury. On neurological examination, he was stuporous with a Glasgow Coma Scale of 8. Routine hematological and serum chemistry testing, including erythrocyte sedimentation rate and C-reactive protein, revealed no abnormality. However, CT scan of the brain revealed severe brain swelling and hemorrhagic contusion in the right frontotemporoparietal (FTP) region. He underwent emergent decompressive craniectomy on the right FTP region (). Postoperatively, he became conscious and was able to obey commands without any neurologic deficit. However, three weeks later, he complained of a febrile sensation and had a temperature of 38.4℃. A CT scan of the brain with intravenous contrast showed a ring-enhanced brain abscess (). Third generation cephalosporin and sufficient hydration were continuously administered. However, despite this management, the fever continued and he complained of mild left hemiparesis (Grade IV+/Grade IV+). A CT scan and magnetic resonance imaging (MRI) with intravenous contrast on hospital day 35 revealed an increase in both the size and extent of the brain abscess (). Navigation-guided culture and biopsy following drainage of the brain abscess using a 5 L catheter were performed. A dark yellowish pus was drained from the abscess. Gram stain and acid-fast bacilli cultures were negative and revealed no organisms. No evidence of granulomas or larval cysts were seen. However, from cultures of the purulent drainage on blood agar, coagulase negative staphylococcus hominis was isolated. His antibiotics were changed to nafcillin and ciprofloxacin based on the results of culture test, and after 6 weeks on antibiotics, he achieved complete clinical recovery except for mild hemiparesis. However, follow-up CT performed 5 months after admission revealed that the brain abscess had developed into a large calcified mass (). Because of its deep-seated location and a lack of clinical symptoms, surgical removal was not performed. Instead, a series of CT scans were taken 3 monthly. No change in either the size or extent of the calcified region was observed over 2 year of follow-up. The patient remains symptom free with mild hemiparesis ().