An Unusual Presentation of Isolated Brain Abscess in Non-Traumatic Convexal Subarachnoid Hemorrhage: A Case Report

Objective: To present a unique case of isolated brain abscess presenting as non-traumatic convexal subarachnoid hemorrhage (cSAH) six days before radiologic signs could be seen. Background: To our knowledge only one other case of due to brain abscess has been reported thus far in the literature. Methods: Presentation of the case report Results: A 42-year old man with no past medical history or prior trauma presented with acute onset of transient left hemianesthesia lasting ten minutes. Computed tomography (CT) of the head revealed We were presented with a diagnostic dilemma when magnetic resonance imaging (MRI) of the brain, magnetic resonance angiography (MRA) of the head and neck, magnetic resonance venography (MRV) and conventional angiography failed to show the cause of Transthoracic and transesophegeal Echo was unremarkable. The patient was discharged in a stable condition, but returned six days later with worsening symptoms, including left hemiparesis. Repeat MRI with contrast revealed a cerebral abscess in the same location as the prior cSAH. Conclusions: cSAH without clear evidence of trauma due to abscess is a rare occurrence. We suggest that in cases of with persistent or worsening symptoms which localize to the site of the hemorrhage, follow-up imaging within seven days should be considered. Disclosure: Dr. Dolla has nothing to disclose. Dr. Wang has nothing to disclose. Dr. Athar has nothing to disclose.