Localized asymptomatic cerebellar abscess after penetrating brain injury by wooden foreign object with adequate antibiotics administration: A case report

Introduction: Brain abscess is a compilation of pus enclosed in capsule as a result of focal infection in brain parenchyma. It is one of several complications found in patients who suffered penetrating brain injury.

Case presentation: Thirty-four-year-old man suffered a penetrating brain injury after a 50 cm piece of wood penetrated through his facial skull and ended its tip in his cerebellum, the wood priorly ejected from a moulding machine. As a consequence, he had to undergo a craniotomy procedure to remove the foreign body object and its debris. Following the surgery, adequate antibiotics were administered. Postoperative enhanced head CT revealed a cystic mass formation in the left hemisphere of cerebellum, measured 20 × 28 mm with blood density lesions and a visible ring enhancement. These features suggested a cerebellar abscess. The follow-up enhanced head CT later demonstrated that the size, shape, and location of the abscess were relatively consistent with the previous head CT.

Discussion: Penetrating brain injury (PBI) is the most life-threatening head trauma. Although the prevalence number was low compared to other head traumas, its morbidity and mortality number were higher. Brain abscess formation is one of the many PBI complications. Due to direct inoculation of foreign body and its debris, PBI commonly leads an infection process. However, the infection process is supposed to be overcome by administering broad-spectrum antibiotics prophylactically. This case presented an inevitable brain abscess despite of the adequate antibiotics administration.

Conclusion: Despite adequate antibiotics has been administered, cerebellar abscess after penetrating brain injury is still found challenging to manage. Therefore, holistic-multidisciplinary approaches are needed.