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Neurological Rehabilitation

Intracranial Abscess of the Basal Ganglia with Left Hemiparesis in a Healthy 18-year-old

Thursday, October 23, 2025
5:00 PM - 6:30 PM MT
Location: Open Kiosks
Has Audio

    Poster Presenter(s)

  • John Defant, MD

    Resident
    Ohio State University Hospital PM&R Program
    Columbus, Ohio

    • Co-Author(s)

  • TH

    Timothy Hake, MD

    Assistant Clinical Professor
    Ohio State University Department of Physical Medicine & Rehabilitation
    Columbus, Ohio

Disclosure(s):
John Defant, MD: No financial relationships to disclose
Case Diagnosis: Intracranial Abscess of the Basal Ganglia with Left Hemiparesis

Case Description or Program Description: A healthy 18-year-old male with a two-week history of nausea, headaches, diarrhea, and fevers presented with rapidly progressive confusion and acute left leg and arm weakness. Exam showed left elbow flexion rigidity and minimal left leg withdrawal. CT head showed a hypodense 2.2 cm lesion in the right posterior frontal lobe with surrounding vasogenic edema and local mass effect, concerning for brain abscess. He underwent right decompressive hemicraniectomy with abscess removal and EVD placement. Tissue sampling revealed streptococcus intermedius. Infectious disease conducted a broad workup that was ultimately unrevealing for pathogen source. CSF studies showed varicella zoster virus, however it was thought this was reactivation secondary to acute illness. He was initially placed on broad spectrum antimicrobials but eventually was treated with prolonged courses of IV ceftriaxone and acyclovir and admitted to inpatient rehabilitation for two weeks.

Setting: Acute Hospitalization and Inpatient Rehabilitation

Assessment/Results: See case description

Discussion (relevance): Intracranial abscesses are rare events, particularly those involving the basal ganglia. It is estimated < 4% of pediatric brain abscesses affect the thalamus and basal ganglia (1). The majority of cases are linked to risk factors including congenital heart disease, sinusitis, otitis, mastoiditis, meningitis, penetrating head trauma, neurosurgical procedures and immune suppression, however, our patient was previously healthy without history high risk behaviors (IV drug abuse). He sustained left sided weakness graded 4/5 left shoulder abduction, 4/5 finger intrinsics, 2/5 hip flexion, 4/5 knee extension, and 3/5 ankle dorsiflexion and plantarflexion (although notably had leg swelling due to post-op DVT). This case benefits the current literature by describing the clinical presentation of an exceedingly rare event with acute neuromuscular findings and rapid clinical deterioration.

Conclusions: A case of acute neuromuscular findings and rapid clinical deterioration secondary to an exceedingly rare abscess of the basal ganglia.