title: Idiopathic pontine Streptococcus salivarius abscess in an immunocompetent patient: management lessons through case illustration and literature review.
abstract: A 55-y-old woman with no previous medical history presented with a 3-day history of progressive headache, nausea, emesis, right-sided facial numbness, and right-sided extremity weakness. Serial magnetic resonance imaging demonstrated rapid enlargement of a left-sided ring-enhancing dorsal pontine lesion with an exophytic portion, raising concern for an abscess. A stereotactically guided left-sided retrosigmoid craniotomy for abscess incision and decompression was performed given the rapid progression of her neurological deficits. Streptococcus salivarius was isolated from the intra-operative samples. After an extensive evaluation, no source for the S. salivarius was identified. Solitary brainstem abscesses are uncommon intracranial infections with high morbidity and mortality. Patients can present with non-specific symptoms and often have no previous medical history. Since 1974, 40 patients with solitary brainstem abscess have survived to hospital discharge. We outline management strategies for solitary brainstem abscess based on a literature review of survivors.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, 645 North Michigan Avenue Suite 900, Chicago, Illinois 60611, USA. a-mandapat@northwestern.edu
authors.forename: Aimee Luna
authors.initials: AL
authors.lastname: Mandapat
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Eddleman
authors.forename: Mei Lin
authors.initials: ML
authors.lastname: Bissonnette
authors.forename: H Hunt
authors.initials: HH
authors.lastname: Batjer
authors.forename: Teresa R
authors.initials: TR
authors.lastname: Zembower
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D001922:Brain Abscess / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D003399:Craniotomy; D019299:Decompression, Surgical; D004322:Drainage; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011859:Radiography; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D013291:Streptococcus / Q000302:isolation & purification* / Q000472:pathogenicity; D016896:Treatment Outcome