A diagnostically challenging case of brain abscess with associated hemorrhage

Background: Brain abscesses with associated hemorrhage are rare. Herein, we present a case of brain abscess with associated hemorrhage that posed a diagnostic challenge. Case Description: A 50-year-old male presented with the left homonymous hemianopia and was admitted to our hospital due to a subcortical hemorrhage in the right occipital lobe, which was revealed during a head magnetic resonance imaging (MRI). Subsequent imaging suggested an intra-tumoral hemorrhage, so surgical treatment was planned. However, on hospital day 6, the patient suddenly showed a decrease in consciousness level. Head MRI showed a high signal within the capsule on diffusion-weighted imaging, which spread to the ventricle and subarachnoid space. Brain abscess was suspected; therefore, an abscess drainage surgery was performed emergency. The postoperative course was relatively smooth. Conclusion: A brain abscess that perforates the ventricle has a poor prognosis, which emphasizes the need for early diagnosis and treatment. Although hemorrhage within a brain abscess is rare, it can complicate diagnosis, which, thus, underscores the importance of awareness.