Brain abscesses following carotid blowout syndrome: a case report

Abstract

We report a case of intracranial abscesses development in a patient with head and neck cancer after emergent treatment of carotid blowout syndrome with coil embolization. Our patient is a 60-year-old male who presented with hemoptysis and hematemesis, which raised concerns for impending carotid blowout syndrome. Endovascular occlusion was successfully achieved, and the patient was discharged in stable condition. Ten days later, the patient reported headaches and right facial pain, and magnetic resonance imaging revealed multiple intracranial abscesses. Broad-spectrum intravenous antibiotics were administered, leading to a variable response with some abscesses decreasing in size and others increasing. Seven weeks from discharge, the patient had no neurological deficits, and all abscesses had decreased in size.

Keywords: Carotid blowout syndrome; Endovascular; Intracranial abscess.

Fig. 1

Coronal (left) and axial (right) CT scan of the neck with contrast showing right common carotid stenosis and pseudoaneurysm.

Fig. 2

Coronal (left) and sagittal (right) diagnostic subtraction angiography of the right common carotid artery showing stenosis and pseudoaneurysm prior to embolization.

Fig. 3

CTA of right neck showing metallic artifact as a result of the vascular plug (left) and successful coil embolization (right).

Fig. 4

Axial noncontrast CT head with areas of hypodensities (circled).

Fig. 5

Axial MRI T1-weighted images with contrast (left) and diffusion-weighted images (right) showing multiple intracranial abscesses in the right cerebral hemisphere.