title: Not just a 'simple stroke'.
abstract: A 51-year-old man presenting with left arm weakness and slurred speech was referred to the acute medical team. Admission chest X-ray showed a cavitating lesion, which had not been present 2 weeks earlier. Systemic enquiry elicited a 2 month prodromal illness and back pain. Urgent CT of his head and chest revealed evidence of thoracic discitis spreading anteriorly into a pleural-based lung abscess and an intracerebral abscess causing his neurological deficit. He was transferred for urgent craniotomy and evacuation of a Streptococcus milleri abscess. Following several weeks of neurosurgical care and antibiotics he made a near full recovery.
authors.affiliation: MBChB(Ed), MRCP. StR4 in General Internal Medicine (Acute). Monklands Hospital. Monkscourt Avenue, Airdrie, ML6 0JS. wends@doctors.org.uk
authors.forename: Wendy
authors.initials: W
authors.lastname: Russell
authors.forename: William
authors.initials: W
authors.lastname: Taylor
authors.forename: Gautamanada
authors.initials: G
authors.lastname: Ray
authors.forename: Jane
authors.initials: J
authors.lastname: Gravil
authors.forename: S
authors.initials: S
authors.lastname: Davidson
mesh_terms: D001922:Brain Abscess / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D003399:Craniotomy; D003937:Diagnosis, Differential; D015299:Discitis / Q000175:diagnosis* / Q000382:microbiology; D016724:Empyema, Pleural / Q000175:diagnosis* / Q000382:microbiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D034364:Streptococcus milleri Group / Q000302:isolation & purification*; D014057:Tomography, X-Ray Computed