Neuroimaging findings: Head CT scan and MRI in multiple cerebral infarctions mimicking cerebral abscesses: A case report and literature review

Abstract

Introduction: A stroke is defined by the American Heart Association (AHA) and the American Stroke Association (ASA) as the sudden onset of neurological deficits lasting over 24 hours or resulting in death, without an apparent cause other than of vascular origin and one of the leading causes of death in developed countries. Acute stroke is diagnosed based on clinical characteristics and radiographic imaging. Acute ischemic stroke and acute intracranial infection can be difficult to distinguish. Case Report: A 37-year-old male patient presented with a 5-day history of impaired verbal responsiveness. Additionally, he reported a 5-month history of right-sided hemiparesis accompanied by headaches, with a noted exacerbation of symptoms over the past two weeks. The patient had uncontrolled hypertension. He had no history of diabetes or cardiovascular disease. He was admitted to the hospital with a blood pressure of 150/80 mmHg. On physical examination, the patient was found to be compos mentis. Motor assessment revealed reduced movement in the right extremities, with muscle strength rated at 4/5, increased muscle tone, and hyperreflexia (3+) in the right extremities. The Babinski reflex was positive on the right side. Sensory evaluation was inconclusive. The computed tomography scan (CT-scan) image without contrast showed bilateral cerebral abscesses; however, magnetic resonance imaging (MRI) of the head without contrast revealed a chronic infarction in the right temporal area and multiple subacute infarctions in the left temporoparietal area. Cerebral digital subtraction angiography (C-DSA) revealed a complete occlusion of the M1 segment of the left middle cerebral artery (MCA). The therapeutic intervention for these patients included the administration of piracetam, aspirin (aspilet), clopidogrel, atorvastatin, and amlodipine. The patients were administered piracetam, aspilet, clopidogrel, atorvastatin, and amlodipine. Conclusion: Patients with cerebral infarction may develop clinical and radiological characteristics that are similar to those of a cerebral abscess. Cerebral abscesses may cause abrupt focal “stroke-like" symptoms, and MRI may show brain lesions with limited diffusion and little contrast enhancement, mimicking an acute infarction.