Effect of rehabilitation on a patient suffering from a tuberculous brain abscess with Gerstmann's syndrome: case report

Abstract

There are few reports in the literature of tuberculous brain abscess. Tuberculous brain abscess usually occurs in an immunocompromised host. Almost all previously documented cases have involved acquired immune deficiency syndrome. We encountered a 53-year-old right-handed immunocompetent male who was initially suspected of having a cerebrovascular accident due to acute-onset right hemiparesis and paresthesia. A tentative diagnosis of brain tumor versus brain abscess was made on imaging studies. The patient was finally diagnosed with a tuberculous brain abscess based upon deterioration on imaging and a positive tuberculosis culture. The tuberculous brain abscess was located in the left parietal lobe, which resulted in Gerstmann's syndrome and right-sided apraxia. Stereotactic surgery was performed. He was also given antituberculosis chemotherapy and comprehensive rehabilitation. Considerable improvement was noted after rehabilitation. The patient even returned to a normal life and work. Our case demonstrates that an aggressive intensive inpatient rehabilitation program combined with stereotactic surgery and effective antituberculosis therapy play an important role in improving the outcome for patients with tuberculous brain abscess, Gerstmann's syndrome, and right-sided apraxia.

Keywords: Gerstmann’s syndrome; rehabilitation; tuberculous brain abscess.

Figure 1

(A) Computed tomography scan at admission showing a brain mass with edema of the peripheral white matter in the left parietal lobe. (B) Brain MRI T2-flair revealed a mass in the left parietal lobe measuring approximately 23 mm × 17 mm, with irregular central necrosis and edema of the peripheral white matter. (C) Brain computed tomography scan obtained two days after admission showing a mass in the left parietal lobe, approximately 32 mm × 22 mm, with central cystic change, ring-like enhancement, and edema of the peripheral white matter.

Figure 2

(A) hematoxylin and eosin stain showing necrotic tissue with neutrophilic infiltration (original magnification × 400). (B) Ziehl–Neelsen stain demonstrating acid-fast bacilli (original magnification × 400).