Hemorrhagic Cerebellar Abscess

BACKGROUND: Brain abscess represents a significant medical problem, accounting for 1 in every 10,000 U.S. hospital admissions and imposing a mortality of 17%-32%. Treatment success depends on early diagnosis, allowing for prompt intervention before a potentially catastrophic rupture. However, diagnosis can be difficult because currently no magnetic resonance imaging signal characteristics are pathognomonic. The presence of hemorrhage may further complicate the radiographic detection of an abscess, potentially leading to delayed treatment. CLINICAL PRESENTATION: A 71-year-old man was diagnosed with hemorrhagic cerebellar abscess as a complication of groin abscess after cardiac catheterization. After surgical resection of the cerebellar abscess and culturebased antibiotic treatment, the patient suffered repeat hemorrhages into the abscess cavity, of which he died. We describe his clinical course with emphasis on radiology-based differential diagnosis. We also describe the possible pathogenesis of this rare case, based on review of the literature. CONCLUSIONS: To our knowledge, this is the first report on recurrent hemorrhages in a cerebellar abscess. Hemorrhagic brain abscess has a complex radiologic appearance, which may delay diagnosis and treatment. A high degree of clinical suspicion is necessary to ensure timely treatment of this potentially lethal lesion.