Open AccessCerebral Nocardiosis: A Rare Cause of Hemiplegia in the Acute Medicine Unit
Author(s) -
HuaJian Liu,
Hannah Simms,
Brian Herron,
S. Hedderwick,
Anne Loughrey,
John R. Lindsay
Publication year - 2019
Publication title -
acute medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.14
H-Index - 12
eISSN - 1747-4892
pISSN - 1747-4884
DOI - 10.52964/amja.0747
Subject(s) - medicine , nocardiosis , hemiparesis , brain abscess , intensive care medicine , neuropathology , nocardia , mycetoma , abscess , medical therapy , antimicrobial , surgery , disease , lesion , chemistry , genetics , organic chemistry , bacteria , biology
Nocardiosis, a rare infection occurring mostly in immunosuppressed patients can present with neurological complications including cerebral abscess formation, and is associated with high morbidity and mortality. We describe the case of a 54-year-old immunocompetent man with cerebral nocardiosis, who presented with sudden onset hemiparesis in an acute medicine unit. He required three craniotomies with excision, following failure to respond to antimicrobial therapy, with subsequent clinical improvement and radiological resolution of multiple cerebral abscesses. Challenges in diagnosis and management of hemiparesis in the acute medical unit are discussed. Successful management of cerebral nocardiosis require early communication with a neurosurgical unit, neuropathology and microbiology services to optimise management with targeted antimicrobial therapy.